# Tolerability of Surgery by Patients With Third Primary Lung Cancer After Second Primary Lung Cancer Surgery

## TL;DR

This study examines the risks and outcomes of third lung cancer surgeries in patients who previously had two lung cancer surgeries.

## Contribution

The study provides insights into the tolerability and outcomes of third surgeries for lung cancer patients.

## Key findings

- The incidence of new or enlarged lung nodules increased over time after the second surgery.
- Most third surgeries involved segmentectomy or wide-wedge resection with notable complication rates.
- Survival rates after the second surgery were high, with no significant difference in prognosis between subgroups.

## Abstract

This study aimed to clarify the incidences and treatments of enlarged nodules detected using imaging findings during follow‐up, surgical outcomes, and prognosis for patients who underwent a second surgery for primary lung cancer.

We included 236 patients who underwent a second surgery for primary lung cancer (> 2 years between first and second surgeries). Group A comprised 205 patients without nodules. Group B comprised 31 patients with nodules that had grown and metachronous lung cancer was suspected; subgroup B1 underwent surgery (23 patients) and subgroup B2 did not (8 patients).

The incidences of new or enlarged intrapulmonary nodules following the second surgery were 0.0091, 0.015, 0.020, 0.024, and 0.029 after 1, 2, 3, 4, and 5 years, respectively. For the third surgery procedure, 83% of the patients underwent segmentectomy and wide‐wedge resection. Ten patients (44%) experienced complications associated with the third surgery including prolonged pulmonary fistulas in 6 patients (26%). The B1 subgroup 30‐day mortality rate after the third surgery was 4.3% (1/23). The 1‐, 2‐, 3‐, 4‐, and 5‐year survival rates after the second surgery in subgroup B1 were 95.7%, 86.3%, 80.9%, 80.9%, and 60.0%, respectively. No significant difference was observed in prognosis between the B1 and B2 subgroups (p = 0.11).

Surgery can be considered effective for third primary lung cancer, notwithstanding associated complications, perioperative mortality, and prognosis.

The incidence of new or enlarged intrapulmonary nodules after the second surgery was 0.0091, 0.015, 0.020, 0.024, and 0.029 after 1, 2, 3, 4, and 5 years, respectively.