Only Surgical Resection Can Identify the Second Primary Lung Cancer out of the Metastasis after Gastric Cancer Surgery

Abstract

Objective: Solitary pulmonary lesions (SPLs) in patients with a history of malignancy require not only the distinction between benign and malignant, but also that between metastatic and primary lesions. We aim to establish the clinical strategy for the treatment of a solitary pulmonary lesion that is detected during the postoperative surveillance for gastric cancer. Methods: We retrospectively examined the clinical records of the patients who underwent curative resection for gastric cancer between January 1999 and December 2009. Patients who were diagnosed with solitary pulmonary lesion during the postoperative surveillance underwent pulmonary resection, and were reviewed with regard to their histological diagnosis and prognosis. Results: Out of a total of 1017 patients who underwent gastric resections during this period, 13 patients with solitary pulmonary lesion underwent pulmonary resection. These tumors were shown to be eight primary lung cancers, four metastatic tumors (three from gastric cancer) and one benign nodule. Of the eight patients with primary lung cancer, seven remained alive after pulmonary resection, including one liver metastasis case, and the other died without recurrence. In contrast, the other three patients with metastasis from gastric cancer died with distant metastasis, despite undergoing curative pulmonary resection. One of these three metastatic patients was misdiagnosed as primary lung cancer by transbronchial biopsy before surgery. Conclusions: Solitary pulmonary lesions detected during postoperative gastric cancer surveillance should undergo surgical resection to distinguish between primary and metastatic disease because of the quite different prognosis of these two entities.

Surgery for lung cancer as the second primary malignancy

“…Surgery for localized pulmonary lesions is necessary because it helps to differentiate primary from metastatic tumors. The same is recommended by Nakamura T. after follow-up study of the operated stomach cancer patients (11). We had no major complications after 2PLC surgery and survival rates were not different according to the primary tumor site, therefore we offer surgical treatment of 2LPC such as the first primary (alone) lung cancer.…”

A quick-frozen section diagnosis of a lung tumor in a patient with a gastric cancer history

“…Unexpectedly, a diagnosis of metastatic adenocarcinoma from the stomach was made. Under the doubt of this diagnostic response, because our experiences taught us it is extremely rare that metastatic lesion in the lung from gastric cancer appear as a solitary nodule like in this case [4] . We dissected #11s lymph node and submitted it to the Diagnostic Pathology Division again for confirmation.…”

“…Nakamura et al reported that out of 13 cases who underwent pulmonary resection for the nodule after curative gastrectomy for gastric cancer (total = 1,017), 8 cases were primary lung cancer and three cases were metastatic lesions from gastric cancer, one from the other organs and one benign nodule. Their (one of us is a coauthor) data also suggest the importance in preoperative diagnosis of the lesions, though the odds are greater for primary lung cancer [4] . Moreover, it has been reported that lymphatic invasion is a more important element in pulmonary metastases from gastric cancer.…”

“…Moreover, it has been reported that lymphatic invasion is a more important element in pulmonary metastases from gastric cancer. All of 13 cases with resected solitary pulmonary metastasis of gastric cancer in two reports, the lymphatic invasion are noticed in the primary site [4,8] . In this case, even retrospective investigation did not disclose lymphatic invasion, and it implied the risk of metastasis was small.…”

An unusual case of lung abscess secondary to round pneumonia caused by recurrent Klebsiella pneumoniae strain and the role of occult metastases tumor

“…Lung is one of the most common sites for metastases tumors including relapse from the gastric adenocarcinoma though it is less common as the initial site of post-operative recurrence of gastric cancer [ 6 ]. The detection of serum CEA on postoperative recurrence was characterized by high specificity though a relatively low sensitivity [ 7 ].…”