Feasibility Of Simultaneous Bilateral Pulmonary Resections By Video-assisted Thoracic Surgery For Multiple Primary Lung Cancers

Objective Surgical treatment has been viewed as the most effective strategy for treating multiple primary lung cancer(MPLC).In recent years,the incidence of MPLC has been gradually increasing,however,the previous studies included a relatively small number of cases,making difference to chooseing surgical procedures by the surgeons for MPLC.In general,simultaneous bilateral pneumonectomy was not recommended in the previous experiences because of its highly invasive nature and serious postoperative complications may occur.The purpose of this study is to discuss the feasibility of simultaneous bilateral pneumonectomy by video-assisted thoracic surgery for multiple primary lung cancer by analyzing the previous cases.Methods According to the diagnostic criteria of multiple primary lung cancer revised by the American College of Chest Physicians(ACCP),we retrospectively analyzed the clinical data of 183 patients with lung cancers pathologically confirmed who underwent unilateral or bilateral pneumonectomy in the same therapeutic group in the department of thoracic surgery of the first affiliated hospital of Dalian medical university from January 2015 to January 2019,and the 61 patients with bilateral lung cancer among them meet the diagnostic criteria of ACCP.All patients underwent operations by video-assisted thoracic surgery,and the clinical data were well preserved.Intraoperative and perioperative variables were evaluated and differences in safety between the groups were compared.Results Unilateral pulmonary resections by video-assisted thoracic surgery was undertaken in 122 patients(group U),and the other 61 patients with bilateral multiple primary lung cancer underwent bilateral pulmonary resections by video-assisted thoracic surgery(group B).The operative time in the bilateral group was significantly longer than that in the unilateral group(213±67.2 vs 120±39.0 min,p<0.001),but it was significantly less than double that in the unilateral group(p=0.016).The operative bleeding volume was not significantly higher in the bilateral group than in the unilateral group(14.6±7.9 vs 12.9±7.3 g,P=0.151).There were no significantly statistically differences in postoperative duration of thoracic tube use,postoperative hospital stay and incidence of postoperative complications between the two groups(p=0.821,p=0.973,p=0.885).The hospitalization costs in the bilateral group was significantly higher than that in the unilateral group(6.92±1.67×10~4vs 5.46±1.03×10~4yuan,p<0.001),but significantly lower than double that in the unilateral group(10.92±2.06×10~4yuan,p<0.001).The bilateral group was further divided into two groups,the group SS and the group SL.And patients in the group SS underwent sublobectomy on both sides,including segmentectomy-segmentectomy(S-S),wedge resection-wedge resection(W-W),and segmentectomy-wedge resection(S-W).Patients in the group SL underwent sublobectomy on one side and lobectomy on an opposite side,including segmentectomy-lobectomy(S-L),wedge resection-lobectomy(W-L).The operative time of group SL was significantly longer than that in group SS(235±50.1 vs 177±49.4 points,p<0.001).The postoperative hospital stay in the group SL was also significantly longer than that in the group SS(5.9±2.9 vs 4.0±1.7 days,p=0.004).There were no significant differences in operative bleeding volume,postoperative duration of thoracic tube use and incidence of postoperative complications between the two groups(P=0.600,P=0.055,P=0.090,respectively).Conclusion For cases of patients with bilateral multiple lesions in lungs,preoperative study should be carried out carefully,and the possibility of MPLC should be considered.On the basis of ensuring safety and principle of treatment,individualized therapeutic regimen are more beneficial to patients.Simultaneous bilateral pneumonectomy with at least sublobectomy on one side is safe for patients with bilateral MPLC.Compared with staging surgery,it can avoid the possibility of tumor development and metastasis,obtain pathological diagnosis timely,contribute to the implementation of the next therapeutic regimen,and it can possibly prolong the survival period of patients.In addition,it can also reduce the costs of staging hospitalization,which benefits patients economically and saves medical costs.The results of this study can provide a reliable foundation for the selection of therapeutic regimen for patients with MPLC.