Abstract / Summary
With widespread low-dose CT screening, multiple primary lung cancer (MPLC) diagnoses have markedly increased. Surgical resection remains the preferred treatment; however, repeat pulmonary resection is technically demanding due to pleural adhesions and altered anatomy from prior surgery, and its safety and oncological outcomes require further validation. A retrospective analysis was performed on the clinical data of 429 patients with MPLC treated between 2015 and 2024 to compare the clinical outcomes between the single resection group ( n = 223) and the repeated resection group ( n = 206). For patients undergoing repeated resections, post-procedural parameters of the first and second surgeries were paired and compared, with subgroup analyses performed based on surgical approach consistency across procedures ( n = 122), ipsilateral resection ( n = 26), and triple resections ( n = 9). Following 1:1 propensity score matching (PSM, 150 pairs), disease-free survival (DFS) and its influencing factors were evaluated and compared between the two groups. In terms of perioperative outcomes, compared with the first procedure, the second procedure in the repeated resection group demonstrated a significantly shorter operative time, as well as reduced intraoperative blood loss and total postoperative drainage volume (all P < 0.05). The overall complication rate of the second procedure was comparable to that of the first procedure (42.72% vs. 50.49%, P = 0.089), although the incidence of gastroparesis was significantly higher (2.91% vs. 0.00%, P = 0.031). Subgroup analyses revealed no significant differences across perioperative parameters between the two procedures in patients with identical surgical approaches (all P > 0.05). Patients undergoing ipsilateral repeated resections experienced a significantly prolonged chest tube drainage duration ( P = 0.015) and a higher overall complication rate (65.38% vs. 34.62%, P = 0.021), driven by an increased incidence of persistent air leak (34.62% vs. 7.69%, P = 0.016). Patients undergoing triple resections maintained stable perioperative metrics; although a trend toward increasing overall complication rates across successive procedures was observed (1st: 44.44%, 2nd: 55.56%, 3rd: 77.78%), this difference did not reach statistical significance ( P = 0.453). Survival analysis demonstrated no significant difference in DFS between the single and repeated resection groups either before ( P = 0.238) or after PSM ( P = 0.395). Pathological stage, micropapillary component, and advanced age were identified as independent prognostic factors for DFS. Repeated pulmonary resection demonstrates favorable perioperative safety in carefully selected patients with MPLC. Following PSM, DFS showed no statistically significant difference between the repeated and single resection groups. Limited by sample size, exploratory analyses suggest that patients in the ipsilateral repeated resection and triple resection subgroups may also derive potential therapeutic benefit; however, larger prospective studies are warranted for further validation.