One-stage resection of four genotypes of bilateral multiple primary lung adenocarcinoma:A case report

BACKGROUND The incidence of multiple primary lung cancer(MPLC)in China is 0.52%-2.45%.Most primary lung cancer cases have reported two lesions or three in rare cases.We report a rare case of bilateral simultaneous multiple primary lung adenocarcinoma of four different genotypes.CASE SUMMARY A 58-year-old woman was admitted to our hospital on June 29,2021,and upon physical examination,four multiple pulmonary nodules were identified in both lungs.Further computed tomography(CT)images revealed the presence of ground glass nodules,predicted to be high-risk cancer lesions by artificial intelligence.With the guidance of three-dimensional reconstruction of preo-perative CT images,the nodules were resected under thoracoscopy.Postoperative pathological investigation revealed that the nodule types were adenocarcinoma in situ,invasive alveolar adenocarcinoma,and microinvasive adenocarcinoma.The excised nodules were further sequenced using high-throughput sequencing(semiconductor sequencing method)of 26 lung cancer genes to confirm that the four lesions were not homologous.The patient was discharged on postoperative day 8,that is,on July 15,2021.One month later,she returned to the hospital for followup and reexamination.Chest CT examination showed that she had re-covered well,and no obvious exudation and effusion were found in both pleural cavities.Evaluation of postoperative pulmonary function showed that her forced vital capacity was 1.40 L(preoperative value,2.27 L)and forced expiratory volume was 1.24 L(preoperative value,2.23 L).CONCLUSION The surgical plan for multiple pulmonary nodules should be carefully considered.For carefully selected patients with concurrently occurring multiple lung nodules in both lungs,sublobectomy is a safe and feasible plan for concurrent bilateral resection of the lesions.Genetic sequencing is necessary for MPLC diagnosis and treatment.

Advances and controversies in the management of early stage nonsmall cell lung cancer

Complete resection continues to be the gold standard for the treatment of earlystage lung cancer.The landmark Lung Cancer Study Group trial in 1995 established lobectomy as the minimum intervention necessary for the management of early-stage non-small cell lung cancer,as it was associated with lower recurrence and metastasis rates than sublobar resection and lower postoperative morbidity and mortality than pneumonectomy.There is a growing tendency to perform sublobar resection in selected cases,as,depending on factors such as tumor size,histologic subtype,lymph node involvement,and resection margins,it can produce similar oncological results to lobectomy.Alternative treatments such as stereotactic body radiotherapy and radiofrequency ablation can also produce good outcomes in inoperable patients or patients who refuse surgery.