The simultaneous and even sequential detection of a tumor in the lung and other organs, until recently, was considered a clear sign of a patient’s hopeless condition. The development of clinical oncology and lung surgery has made it possible to make wider use of surgical methods for the treatment of lung cancer in case of primary multiple malignant tumors. It turned out that the results of surgical treatment of such patients are quite comparable with the long-term results of surgical treatment of primary lung cancer. So, according to A.Kh.Trachtenberg et al. (1986) 5-year survival in lung cancer patients with a primary multiplicity of tumors after radical surgery was 36.7%. At the same time, the 5-year survival rate for synchronous malignant tumors was 25%, while for metachronous – 59.3%.The 5-year survival rate for lung cancer of the first stage in combination with malignant tumors of other localizations was 83.8%, stage II -44.4%, stage III -35.7%.
We have some experience in the surgical treatment of lung cancer in multiple primary tumors. A total of 67 patients were operated on. Reliably traced the fate of 28 patients who were treated at the clinic of thoracic surgery in 1994— biennium. with synchronous tumor of the lungs and other organs. Of these, 12 had cancer of the lung and kidney, 8 had cancer of the lung and larynx, 4 had cancer of the lung and stomach, in 3 cases, cancer of the lung and colon. One patient, 66 years old, underwent simultaneous removal of a brain tumor, the upper lobe of the right lung and the left kidney. The outcome of surgery is favorable. The patient is in a satisfactory condition and has been observed by us for three years. There are no signs of recurrence of the tumor process.
The tactics of surgical treatment of lung cancer in combination with malignant neoplasms of other organs, as a rule, is determined by the localization of the tumor, the timing of its occurrence and the prevalence, the presence of complications, operational risk factors, etc.
In the case of the detection of metachronous tumors in tactical terms there are no fundamental differences from the treatment of cancer of a certain localization. Operations are performed sequentially, as tumors are detected.
Much more difficult is the question of surgical tactics for synchronous primary multiple tumors. From our point of view, the most expedient is the speedy single-stage removal of all malignant neoplasms. The common opinion among surgeons about the possibility of performing simultaneous operations only in a relatively small number of patients is, in our opinion, somewhat exaggerated. Modern possibilities of anesthesiology, resuscitation and thoracic surgery allow one-step operations to be performed successfully. Naturally, the functional reserves of patients in the preoperative period should be carefully assessed.
If, for any reason, it is not possible to perform a single-step operation, a second intervention is possible 4 to 4 weeks after the first one. In such cases, the first operation should begin with the removal of the tumor, characterized by a more rapid and malignant course and greater prevalence.
At present, the expediency of active surgical tactics for solitary metastases to the lungs, in which segmental or wedge resection is performed, has also been established.
The main operations for lung cancer in combination with malignant neoplasms of various organs are advanced pneumonectomy and lobectomy, advanced combined operations and pulmonary resection in combination
resection of the bronchi. The choice of an operation depends on the prevalence of the tumor process, the histological structure of the tumor and the functional state of vital organs and systems. The technique of these operations is described in detail in the previous sections of the chapter.
If it is impossible to carry out surgical treatment, one should raise the question of radiation or drug antitumor treatment.
Among our patients, 71.4% experienced a year after surgery, two years –53.6%, three or more years –39.3%