Surgical outcomes of one-stage resection for synchronous multiple primary lung adenocarcinomas with no less than three lesions

Abstract Background More and more synchronous multiple primary lung adenocarcinomas (SMPLA) have been diagnosed and surgical treatment has become the mainstay of treatment for them, but there are few reports on the surgical outcome of patients with ≥ 3 lesions who underwent surgical resection. Therefore, we summarized and analyzed the clinical characteristics and surgical outcomes of these patients, hoping to provide some experience in the diagnosis and treatment. Methods Clinical characteristics and treatment outcomes of patients with ≥ 3 lesions who have been diagnosed as SMPLA and underwent surgical resection in our hospital from March 2015 to July 2019 were retrospectively reviewed. Results Twenty-eight patients, 20 females and 8 males, with a mean age of 57.7 ± 5.69 (45–76) years, were finally included. A total of 95 lesions, 86.4% were ground-glass opacity (GGO) lesions (pure-GGO,45.3%; mixed-GGO,41.1%); 51 lesions had EGFR mutations and the mutation rate of invasive adenocarcinoma was significantly higher than that of other pathological subtypes (P < 0.001); the mutation rate of mGGO was also significantly higher than that of pGGO and solid nodule (SN) (P < 0.05). Four and 24 patients respectively underwent bilateral and unilateral surgical resection. The surgical procedure was mainly sublobar resection, and no severe postoperative complications or deaths occurred. After a median follow-up time of 32.2 months, the rates of overall survival and disease-free survival at 3 years were 94.7% and 88.9%, respectively. Conclusions For SMPLA with ≥ 3 lesions, one-stage resection may be safe and feasible, and surgical procedure was mainly sublobar resection as far as possible, which can yield satisfactory prognosis. EGFR mutation testing should be used routinely in the diagnosis and treatment of patients with SMPLA, especially in the presence of mGGO and invasive adenocarcinoma.

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Clinical Features and Surgical Treatment of Synchronous Multiple Primary Lung Adenocarcinomas With Different EGFR Mutations

Frontiers in Oncology ◽

10.3389/fonc.2021.785777 ◽

2022 ◽

Vol 11 ◽

Author(s):

Rirong Qu ◽

Fan Ye ◽

Dehao Tu ◽

Yixin Cai ◽

Xiangning Fu

Keyword(s):

Clinical Features ◽

Mutation Rate ◽

Surgical Outcomes ◽

Clinical Characteristics ◽

Egfr Mutations ◽

Driver Gene ◽

Invasive Adenocarcinoma ◽

Significant Difference ◽

Multiple Primary ◽

Lung Adenocarcinomas

BackgroundWith the popularity of lung cancer screening and advances in imaging technology, more and more synchronous multiple primary lung adenocarcinomas (SMPLA) are being diagnosed clinically, however, the clinical characteristics and prognosis of SMPLA with different EGFR mutations remains unclear. We aimed to explore clinical features and surgical outcomes of these patients to aid in the diagnosis and treatment of SMPLA.MethodsMedical records of patients with different EGFR mutations who have been diagnosed as SMPLA and underwent surgical resection from March 2015 to December 2019 were retrospectively analyzed. Clinical characteristics, surgical outcomes, recurrence-free survival (RFS) and overall survival (OS) were investigated.ResultsA total of 70 patients (68.6% female and 77.1% non-somkers) were included. Total of 161 lesions in all patients, 84.4% were ground-glass opacity (GGO) lesions. EGFR mutations were detected in 108 lesions, most of which were L858R (35.4%) and 19Del (20.5%). The mutation rate of mixed GGO is significantly higher than that of pure GGO and solid nodules (SN); the mutation rate of invasive adenocarcinoma is significantly higher than that of other histology subtypes; the mutation rate of lesions >20 mm was significantly higher than that of ≤20 mm. However, there is no significant difference in the mutation rate of specific driver gene between different radiological features, pathological characteristics and sizes. After a median follow-up time of 29 months, the 3-year OS and RFS were 94.4% and 86.0%, respectively.ConclusionsA high discordance of EGFR mutations were identified between tumors in patients with SMPLA. Synchronous multiple lung adenocarcinomas with predominantly multiple GGO should be considered as SMPLA, and surgery may be aggressively performed for these patients due to a good prognosis.

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Clinical Features and Surgical Treatment of Synchronous Multiple Primary Lung Adenocarcinomas With Different EGFR Mutations

10.21203/rs.3.rs-508833/v1 ◽

2021 ◽

Author(s):

Rirong Qu ◽

Fan Ye ◽

Shaojie Hu ◽

Wei Ping ◽

Yixin Cai ◽

...

Keyword(s):

Clinical Features ◽

Mutation Rate ◽

Surgical Outcomes ◽

Ground Glass Opacity ◽

Egfr Mutations ◽

Driver Gene ◽

Invasive Adenocarcinoma ◽

Significant Difference ◽

Multiple Primary ◽

Lung Adenocarcinomas

Abstract Purpose: We aimed to explore clinical features and surgical outcomes of synchronous multiple primary lung adenocarcinomas (SMPLA) with different EGFR mutations to aid in the diagnosis and treatment of SMPLA.Methods: Medical records of patients with different EGFR mutations who have been diagnosed as SMPLA and underwent surgical resection from March 2015 to December 2019 were retrospectively analyzed. Clinical characteristics, surgical outcomes, recurrence-free survival (RFS) and overall survival (OS) were investigated.Results: A total of 70 patients ( 68.6% female and 77.1% non-somkers) were included. Total of 161 lesions in all patients, 84.4% were ground-glass opacity (GGO) lesions. EGFR mutations were detected in 108 lesions, most of which were L858R (35.4%) and 19Del (20.5%). The mutation rate of mixed GGO is significantly higher than that of pure GGO and solid nodules (SN); the mutation rate of invasive adenocarcinoma is significantly higher than that of other histology subtypes; the mutation rate of lesions >20 mm was significantly higher than that of ≤20 mm. However, there is no significant difference in the mutation rate of specific driver gene between different radiological features, pathological characteristics and sizes. After a median follow-up time of 29 months, the 3-year OS and RFS were 94.4% and 86.0%, respectively.Conclusions: A high discordance of EGFR mutations were identified between tumors in patients with SMPLA. Synchronous multiple lung adenocarcinomas with predominantly multiple GGO should be considered as SMPLA, and surgery may be aggressively performed for these patients due to a good prognosis.

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Preoperative non-invasive visual localization of synchronous multiple lung cancers using three-dimensional computed tomography lung reconstruction

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01666-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Guofei Zhang ◽

Duo Xu ◽

Zipu Yu ◽

Lian Wang ◽

Haihua Gu ◽

...

Keyword(s):

Computed Tomography ◽

Three Dimensional ◽

Ground Glass ◽

Visual Localization ◽

Sublobar Resection ◽

Invasive Adenocarcinoma ◽

Lung Cancers ◽

Non Invasive ◽

Multiple Primary ◽

The Mean

Abstract Background Synchronous multiple primary lung cancers are becoming more common with increasing use of computed tomography for screening. Intraoperative localization and resection of ill-defined pulmonary ground-glass opacities during thoracoscopic resection is challenging. This study aimed to determine the clinical feasibility of non-invasive visual localization of these nodules by three-dimensional computed tomography lung reconstruction before sublobar resection. Methods Forty-four patients with synchronous multiple primary lung cancers underwent thoracoscopic pulmonary resection at our institution between June 2017 and August 2019. Preadmission computed tomography images were downloaded and reconstructed into a three-dimensional model. Small nodules (< 15 mm) were localized non-invasively by three-dimensional computed tomography lung reconstruction before surgery. Patient demographics, nodule characteristics, procedural details, pathological data, and outcomes were obtained from the medical records. Results One hundred and twenty-one pulmonary nodules from the 44 patients were scheduled for video-assisted thoracic surgery; 54 (44.6%) were pure ground-glass opacities and 57 (47.1%) were mixed ground-glass opacities. One hundred and seventeen nodules were localized preoperatively. The mean nodule diameter was 7.67 ± 3.87 mm. The mean distance from the nodule to the pleura was 14.84 ± 14.43 mm. All nodules were removed successfully by wedge resection (27 patients), lobectomy (26 patients), or segmentectomy (25 patients). Most lesions (85.1%) were malignant. Paraffin pathology revealed 12 cases of atypical adenomatous hyperplasia (9.92%), 13 of adenocarcinoma in situ (10.74%), 16 of minimally invasive adenocarcinoma (13.22%), and 73 of invasive adenocarcinoma (60.33%). Conclusions Three-dimensional computed tomography lung reconstruction is a feasible and alternative method of visual localization for small lung nodules before sublobar resection in some suitable patients.

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One-Stage Soft Tissue Reconstruction Following Sarcoma Excision: A Personalized Multidisciplinary Approach Called “Orthoplasty”

Journal of Personalized Medicine ◽

10.3390/jpm10040278 ◽

2020 ◽

Vol 10 (4) ◽

pp. 278

Author(s):

Andrea Angelini ◽

Cesare Tiengo ◽

Regina Sonda ◽

Antonio Berizzi ◽

Franco Bassetto ◽

...

Keyword(s):

Surgical Resection ◽

Lower Limbs ◽

Surgical Approaches ◽

Soft Tissue Reconstruction ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

One Stage ◽

Unplanned Excision ◽

Increased Risk ◽

Toronto Extremity Salvage Score

Background and Objectives. Wide surgical resection is a relevant factor for local control in sarcomas. Plastic surgery is mandatory in demanding reconstructions. We analyzed patients treated by a multidisciplinary team to evaluate indications and surgical approaches, complications and therapeutic/functional outcomes. Methods. We analyzed 161 patients (86 males (53%), mean age 56 years) from 2006 to 2017. Patients were treated for their primary tumor (120, 75.5%) or after unplanned excision/recurrence (41, 25.5%). Sites included lower limbs (36.6%), upper limbs (19.2%), head/neck (21.1%), trunk (14.9%) and pelvis (8.1%). Orthoplasty has been considered for flaps (54), skin grafts (42), wide excisions (40) and other procedures (25). Results. At a mean follow-up of 5.3 years (range 2–10.5), patients continuously showed no evidence of disease (NED) in 130 cases (80.7%), were alive with disease (AWD) in 10 cases (6.2%) and were dead with disease (DWD) in 21 cases (13.0%). Overall, 62 patients (38.5%) developed a complication (56 minor (90.3%) and 6 major (9.7%)). Flap loss occurred in 5/48 patients (10.4%). The mean Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage Score (TESS) was 74.8 ± 14 and 79.1 ± 13, respectively. Conclusions. Orthoplasty is a combined approach effective in management of sarcoma patients, maximizing adequate surgical resection, limb salvaging and functional recovery. One-stage reconstructions are technically feasible and are not associated with increased risk of complications.

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