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

Purpose 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. Methods 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). Results 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). Conclusion Surgery can be considered effective for third primary lung cancer, notwithstanding associated complications, perioperative mortality, and prognosis.