Intrapulmonary sublesions detected before surgery in patients with lung cancer

Abstract

BACKGROUND: The treatment of patients with multiple intrapulmonary lesions remains controversial. METHODS: Fifty-three patients with lung cancer, in whom preoperative evaluation disclosed intrapulmonary nodules distinct from the main tumor, were analyzed retrospectively to establish the optimal treatment in such cases. RESULTS: These sublesions proved to be intrapulmonary metastases (PM) in 16 cases (30%), multiple primary lung cancers in 7 cases (13%), and various nonmalignant lesions in the others. The survival of the 53 patients, and of patients with clinical Stage I/II disease in particular, compared favorably with that of all patients with resected lung cancer. Those with multiple sublesions had a poorer prognosis, irrespective of their nature. Although patients with PM as sublesions often had clinically advanced cancer, metastatic foci, per se, did not influence the survival data as calculated by a multivariate analysis. CONCLUSIONS: The authors conclude that the existence of a solitary intrapulmonary sublesion should not preclude surgical treatment, unless surgery is contraindicated because of other clinical and radiologic findings.