• Aritoshi Hattori, Takeshi Matsunaga, Yukio Watanabe, Mariko Fukui, Kazuya Takamochi, Shiaki Oh, and Kenji Suzuki.
• Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan. Electronic address: ahattori@juntendo.ac.jp.
• J. Thorac. Cardiovasc. Surg. 2021 Nov 1; 162 (5): 1389-1398.e2.

ObjectivesWe investigated the surgical outcomes of repeated pulmonary resection for metachronous ipsilateral second non-small cell lung cancer (NSCLC).MethodsA retrospective review identified 104 (3.6%) patients who underwent surgical resection for ipsilateral metachronous second NSCLC. Repeated anatomical (reanatomical) resection was defined as a metachronous anatomical surgery for secondary NSCLC after ipsilateral primary major lung resection for NSCLC. Operative morbidity or other clinicopathologic factors were analyzed by a multivariable model. Overall survival (OS) was evaluated using Cox proportional hazard model.ResultsSeventy-seven (74%) patients were diagnosed as second primary cases. The 3-year OS after metachronous surgery for ipsilateral second NSCLC was 80.1%, and that of reanatomical resection was equivalent to the other procedures (reanatomical: 81.8%, others: 78.2%, P = .816), whereas reanatomical resection (n = 56) was a significant predictor of postoperative severe morbidity after ipsilateral second pulmonary resection (P = .036) that was found in 23 (41%) patients. When this procedure was classified into 2 groups, ie, completion pneumonectomy (CP; n = 26) and other reanatomical resection to avoid CP (non-CP; n = 32), non-CP was significant on the right side (P = .011), whereas intrapericardial procedure was employed frequently for both (CP: 85%, non-CP: 47%). In contrast, the oncologic outcome (3-year OS; 75.8% vs 87.1%, P = .881) and several surgical outcomes including morbidities were similar between CP and non-CP.ConclusionsReanatomical pulmonary resection showed acceptable oncologic outcomes for metachronous ipsilateral second NSCLC. The non-CP procedure was technically challenging; however, both oncologic and surgical results were feasible compared with the CP. This procedure might be a promising novel strategy for properly selected ipsilateral second NSCLC.Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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