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J Thorac Cardiovasc Surg 2003;126:1597-1601
© 2003 The American Association for Thoracic Surgery

General thoracic surgery

Resection of multifocal non–small cell lung cancer when the bronchioloalveolar subtype is involved

^a Divisions of Cardiothoracic Surgery, Sacramento, Calif, USA
^b Hematology/Oncology, University of California, Davis, Medical Center, Sacramento, Calif, USA

Read at the Twenty-eighth Annual Meeting of The Western Thoracic Surgical Association, Big Sky, Mont, June 19-22, 2002.

Received for publication July 10, 2002; revisions received August 19, 2002; revisions received April 3, 2003; accepted for publication April 22, 2003.

^* Address for reprints: Peter F. Roberts, MD, Department of Surgery, Cypress Building, 2nd Floor, Room 2113, UCDMC, 2221 Stockton Blvd, Sacramento, CA 95817, USA
peter.roberts{at}ucdmc.ucdavis.edu

OBJECTIVE: Bronchioloalveolar lung cancer is commonly multifocal and can also present with other non–small cell types. The staging and treatment of multifocal non–small cell cancer are controversial. We evaluated the current staging of multifocal bronchioloalveolar carcinoma and the therapeutic effectiveness of resection when this tumor type is involved.

METHODS: We reviewed our experience between 1992 and 2000 with complete pulmonary resections for bronchioloalveolar carcinoma. Kaplan-Meier survival curves were calculated from the dates of pulmonary resection.

RESULTS: Among 73 patients with bronchioloalveolar carcinoma, 14 patients, 7 male and 7 female with a mean age of 65 years (51-87 years), had multifocal lesions without lymph node metastases. Follow-up was 100% for a median of 5 years (range 2.6-8.5 years). Tumor distribution was unilateral in 9 patients and bilateral in 5 patients. The multifocal nature of the disease was discovered intraoperatively in 4 patients. Nine patients had 2 lesions, 4 patients had 3 lesions, and 1 patient had innumerable discrete foci in a single lobe. Operative mortality was 0. Postoperatively, 10 patients were staged pIIIB or pIV on the basis of multiple foci of similar morphology; 4 patients had some differences in histology (implying multiple stage 1 primaries). The median survival time to death from cancer was 14 months (141 days–5.6 years). The overall 5-year survival after resection of multifocal bronchioloalveolar carcinoma was 64%. Unilateral or bilateral distribution had no impact on survival.

CONCLUSIONS: The current staging system is not prognostic for multifocal bronchioloalveolar carcinoma without lymph node metastases. Complete resection of multifocal non–small cell lung cancer when bronchioloalveolar carcinoma is a component may achieve survivals similar to that of stage I and II unifocal non–small cell lung cancer. When bronchioloalveolar carcinoma is believed to be one of the cell types in multifocal disease without lymph node metastases, consideration should be given to surgical resection.

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