Resection for Metachronous Lung Cancer Developing after Pneumonectomy

The mortality and morbidity of resection for metachronous cancer after pneumonectomy is controversial. Operation of the contralateral lung is often contraindicated. A 78 years old man staged as T3N1M0 who underwent left-sided pneumonectomy was found to have a second primary tumor during follow-up after 19 years. The patient was prediagnosed as metachronous cancer and a muscle sparing right anterolateral thoracotomy was done. A mass of 3x2x2 cm located at the right basal superior segment involving visceral pleura was resected by superior segmentectomy and an apical bulla found at the apex was also resected. Mediastinal and hilar nodal dissection was done. The postoperative histopathological diagnosis of the mass was moderately differentiated squamous carcinoma and the lymph nodes were pathologically reported as lymphoid hyperplasia. The patient's drainage was removed on postoperative third day. He has been follow-up for the last 2 years and no relapse or metastasis is detected since then. The role of resection in a case developing metachronous cancer after 19 years following pneumonectomy was discussed in view of literature.