Association of the Extent of Resection with Survival in Multiple Primary Lung Cancer: A Systematic Review

Abstract

Background The incidence of synchronous multiple primary lung cancer (SMPLC) has progressively increased, due to recent advances in imaging. To date, no guidelines defining recommendations for patients' selection and no standard treatment of cases with SMPLC have been defined.

The primary aim of this systematic review was to assess survival among patients treated with lobectomy or sublobar resection MPLC.

Methods Comprehensive literature search of Medline, the Cochrane Library, reference lists, and ongoing studies was performed according to a prospectively registered design (PROSPERO: CRD42019115487). All studies published between 1998 and December 2020 that examined treatments with lobectomy compared to sublobar resection were included. Two double-blind investigators independently selected articles.

Primary outcomes were to assess the 5-year overall survival (OS) rate among patients treated with lobectomy or sublobar resection and the impact of lymph node status on 5-year OS and 5-year disease-free survival in patients with MPLC.

Results The search yielded 424 articles; 4 observational studies met the inclusion criteria and collectively evaluated 298 patients with a mean age ranging from 61.5 to 67 years. A total of 112 patients were treated for bilateral synchronous tumors and 186 patients for unilateral multiple synchronous tumors. All included studies showed that the type of resection, lobectomy or limited resection, had no significant impact on survival.

Conclusion Limited resection is a valuable treatment option for MPLC. However, the clinical level of evidence of the studies found is low and randomized studies are needed to clarify the extent of resection in MPLC.

Keyword

lung cancer treatment (surgery medical) - thoracoscopy/VATS - surgery - complications - lung cancer - diagnosis

Competing Interests

Authors declare no competing interests.

Authors' Contributions

N.T., F.L., and C.B. contributed to the conception or design of the work. N.T. wrote the manuscript with support from F.L., P., and M.C. G.V. and R.C. verified the analytical methods and provided interpretation of data for the work. G.C., S.M., and G.A. supervised the findings of this work and provided critical feedback. A.S. and A.C. revised the work critically for important intellectual content. All authors discussed the results and contributed to the final approval of the manuscript.

Support

No financial statement was received for the review.

Publication History

Received: 23 November 2021

Accepted: 03 January 2022

Article published online:
25 February 2022

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