A Case of Metachronous Multiple Lung Cancers That Underwent Two Separate Solitary Wedge Resections After Right Pneumonectomy

Background. Little information exists regarding the outcome of subsequent lung operations for lung cancer after pneumonectomy. Most reported cases underwent only a second operation after pneumonectomy. Case. A 45-year-old man was admitted to our hospital with an abnormal shadow on chest X-ray. Chest CT showed a tumor shadow in the S6 segment of the right lung which invaded the right main bronchus. Right pneumonectomy and lymph node dissection (ND2a) were performed. Pathological examination revealed squamous cell carcinoma (pT3N1M0, Stage IIIA). Five years later, chest CT showed a tumor shadow in the lower lobe of the left lung. His pulmonary function was sufficient to allow a second operation. Wedge resection of the lower lobe of the left lung was performed. Pathological examination revealed squamous cell carcinoma 16 mm in diameter which was classified as metachronous lung cancer according to the Martini criteria. However, 44 months later, chest CT showed a tumor shadow on the border of a bulla in the upper lobe of the left lung. On positron emission tomography, the tumor revealed weak accumulation of fluorodeoxyglucose. Although spirometry revealed mixed pulmonary dysfunction, his performance status was good. He wanted to receive a third operation. Wedge resection of the upper lobe of the left lung was performed. Pathological examination revealed adenocarcinoma 15 mm in diameter. His post-operative course was uneventful. His performance status declined slightly, but he had no problem in daily life. The patient is alive 17 months after the third operation without any sign of recurrence. Conclusion. We encountered a patient with metachronous multiple lung cancers who underwent two separate solitary wedge resections of the left lung after right pnuemonectomy. We believe this aggressive surgical approach led to 10-year survival from the first operation.