Repeated Anatomical Pulmonary Resection for Second Primary Nonsmall‐Cell Lung Cancer: Safety and Short‐Term Outcomes

ABSTRACT

Background

Repeated anatomical pulmonary resections in second primary nonsmall‐cell lung cancer (NSCLC) pose significant challenges due to prior surgery. This study evaluates the feasibility and short‐term outcomes of repeated anatomical pulmonary resections for second primary NSCLC.

Method

We retrospectively reviewed all consecutive cases of repeated anatomical pulmonary resections for second primary NSCLC performed in our institution from January 2014 to December 2023.

Results

A total of 55 patients (median age 68 years; interquartile range [IQR]: 61.5–72) underwent repeated anatomical pulmonary resections for second primary NSCLC. Adenocarcinoma predominated in both primary (78.2%) and secondary (76.4%) cases. Video‐assisted thoracoscopy (VATS) approach was used in 94.5% and 96.4% for first and repeated resection, respectively (p = 0.647). The extent of pulmonary resection differed between first and repeated resection, with a predominance of lobectomy during first resection (56.4%) and segmentectomy during repeated resection (85.5%, p < 0.001). We did not observe any significant difference in postoperative overall morbidity after first and repeated resection (23.6% vs. 40%, p = 0.065). However, there was an increased incidence of atrial fibrillation (16.4% vs. 0%) and prolonged air leak (> 5 days) after repeated resection (25.5% vs. 5.5%, p = 0.008). The median length of hospital stay was similar after first and repeated resection (5 vs. 5 days, p = 0.089). The three‐year overall survival (OS) was 73% after first resection and 87% after repeated resection. Overall disease recurrence rate was not statistically different between first and repeated resection (1.8% vs. 3.6%, p = 0.558).

Conclusion

Our series demonstrated that second primary NSCLC can be safely managed by VATS segmentectomy, yielding favorable short‐term survival and low recurrence rates.

In 55 patients with second primary nonsmall‐cell lung cancer (NSCLC), repeated anatomical video‐assisted thoracoscopic surgery (VATS) resections—mostly segmentectomies—were safe and effective. Despite a higher rate of air leak and atrial fibrillation, morbidity and length of stay were similar to initial surgery. Three‐year survival reached 87%, with low recurrence. These findings support minimally invasive, parenchyma‐sparing reoperations in selected patients.

1. Introduction

Nonsmall‐cell lung cancer (NSCLC) remains one of the leading causes of cancer‐related mortality worldwide [1]. Advances in early detection, surgical techniques, and systemic therapies have significantly improved survival rates, leading to an increasing number of patients presenting with second primary NSCLC [2, 3]. The reported incidence of second primary NSCLC ranges between 2% and 20%, depending on patient characteristics, follow‐up duration, and imaging surveillance [4, 5]. Surgical resection remains the mainstay of treatment for early‐stage NSCLC. Yet, the feasibility and safety of repeated anatomical pulmonary resections in patients with prior lung surgery pose significant challenges. Furthermore, there is limited data on functional outcomes and complications, specifically for repeated NSCLC resections. Indeed, performing a repeated pulmonary resection is inherently more complex due to surgical adhesions, altered anatomical landmarks, and potential deterioration of pulmonary function. Moreover, concerns about perioperative morbidity and functional outcomes often guide surgical decision‐making [6, 7]. Parenchymal‐sparing approaches, such as segmentectomy, become attractive procedures in these cases, offering the advantage of preserving lung function while achieving oncological control [8, 9], yet their role in the context of repeat resections remains incompletely defined.

Minimally invasive techniques, particularly video‐assisted thoracoscopic surgery (VATS), and, more recently, robot‐assisted thoracic surgery (RATS), have revolutionized the surgical management of lung cancer by reducing perioperative complications, shortening hospital stays, and improving recovery [10, 11]. The potential benefits of VATS in repeated lung resections are particularly relevant, given the increased technical difficulties associated with reoperation. Despite these advancements, limited data exists on the safety and efficacy of repeated anatomical pulmonary resections, particularly segmentectomy, for second primary NSCLC.

This study aims to evaluate the feasibility and short‐term outcomes of repeated anatomical pulmonary resections for second primary NSCLC, focusing on surgical morbidity and oncological outcomes.

2. Methods

2.1. Study Design and Patient Selection

This retrospective single‐center study analyzed all consecutive patients with a history of anatomical pulmonary resection for primary NSCLC who subsequently underwent a repeated anatomical pulmonary resection for a second primary NSCLC between January 2014 and December 2023. All procedures were performed by one of four experienced, board‐certified thoracic surgeons at Lausanne University Hospital.

Eligible patients were adults (≥ 18 years) who had undergone an anatomical pulmonary resection with mediastinal lymphadenectomy for primary NSCLC, followed by a repeated anatomical pulmonary resection for a newly diagnosed second primary NSCLC. The definition of second primary NSCLC was based on the 1975 Martini‐Melamed criteria: (i) distinct histological types or (ii) identical histology, provided that at least one of the following conditions is met: a disease‐free interval exceeding 2 years, carcinoma in situ as the origin, the second tumor located in a different lobe or lung, and the absence of lymphatic spread or extrapulmonary metastases at diagnosis [12]. Second primary NSCLC was classified as synchronous or metachronous based on a cutoff of 24 months [13]. Patients were excluded if they underwent only sublobar wedge resection or if they had small‐cell lung carcinoma.

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). This study was approved by the local ethics committee (CER‐VD in Lausanne, Switzerland) (referral number: (N°2024_02079)), which waived the need to obtain informed patient consent.

2.2. Data Collection

Clinical data was retrospectively extracted from a prospectively maintained electronic database. Collected variables included patient demographics, comorbidities, preoperative pulmonary function tests, and American Society of Anaesthesiologists (ASA) classification. Tumor characteristics of both primary and secondary NSCLC were documented, encompassing histology, anatomical location, number of dissected lymph nodes, and TNM staging (8th edition). Surgical parameters for both interventions were recorded, including the surgical approach, extent of resection, and operative duration. Postoperative outcomes included 90‐day morbidity, 30‐day mortality, hospital readmissions, reoperations, chest drainage duration, and length of hospital stay. Additionally, recurrence status and survival outcomes were collected, with overall survival (OS) calculated from the date of surgery (first or repeated resection) to death or last follow‐up.

Postoperative morbidity was defined as any complication occurring within 90 days after surgery that altered patient management. Cardiac complications included arrhythmias, myocardial ischemia, and heart failure, while pulmonary complications included pneumonia, pneumothorax, hemothorax, pleural empyema, prolonged air leak (> 5 days), acute respiratory distress syndrome, subcutaneous emphysema, and chylothorax.

The primary outcome measure was the feasibility of repeated anatomical pulmonary resection, assessed through surgical approach, type of resection, thoracotomy conversion rate, and operative time. Secondary outcomes included postoperative morbidity, mortality, duration of chest drainage, length of hospital stay, as well as rates of readmission and reoperation.

2.3. Surgical Management

All cases were discussed in a multidisciplinary tumor board to establish an optimal treatment plan. Tumor biopsies were obtained via radial endobronchial ultrasound (EBUS) or percutaneous image‐guided techniques. The preoperative oncological evaluation included a chest CT scan, fluorodeoxyglucose positron emission tomography (¹⁸F‐FDG PET‐CT) and a brain MRI to rule out cerebral metastases. In patients with suspected lymph node involvement on imaging, tissue sampling was conducted via EBUS‐guided fine‐needle aspiration or mediastinoscopy.

Preoperative functional assessment included transthoracic echocardiography and spirometry. If the forced expiratory volume in 1 s (FEV1) or diffusing capacity of the lung for carbon monoxide (DLCO) was below 80% of predicted values, cardiopulmonary exercise testing was performed.

Surgery was conducted under general anesthesia with double‐lumen endotracheal intubation to enable single‐lung ventilation. Video‐assisted thoracoscopic surgery (VATS) was performed using a three‐port anterior approach or a uniportal approach based on surgeon preference. When required, a posterolateral thoracotomy was performed. Anatomical resection was achieved by individual dissection and division of bronchovascular structures. Segmentectomy was favored for peripheral tumors measuring < 2 cm in diameter or when pulmonary functions would not allow a lobectomy. In cases requiring precise delineation of segmental borders, indocyanine green fluorescence imaging was used. Systematic mediastinal lymphadenectomy was performed in all patients. Intraoperative frozen section analysis was conducted on parenchymal margins or lymph nodes in cases of suspected malignancy.

Perioperative and postoperative care adhered to the principles of an enhanced recovery after surgery (ERAS) protocol [14, 15].

Following resection, all cases were reassessed in a multidisciplinary tumor board to determine the need for adjuvant therapy. Postoperative surveillance included chest CT scans at 3‐month intervals for the first 2 years, followed by biannual imaging up to 5 years postsurgery.

2.4. Statistical Analysis

The Kolmogorov–Smirnov and Shapiro–Wilk tests confirmed the abnormal distribution of all continuous variables. Categorical variables were reported as absolute numbers and percentages, while continuous variables were expressed as means with standard deviation for normally distributed data or medians with interquartile ranges (IQR) for non‐normally distributed data (including age, number of dissected lymph nodes, operative time, duration of drainage, and postoperative length of stay). Comparisons between the first and repeated NSCLC resections were conducted using either the unpaired Student t‐test for normally distributed numerical variables or the Mann–Whitney U‐test for non‐normally distributed data. Categorical variables were analyzed using the chi‐squared test. OS was estimated using the Kaplan–Meier method and compared between groups with the log‐rank test. A p < 0.05 was considered statistically significant. All analyses were performed using Stata software, version 18 (StataCorp, College Station, TX, USA).

3. Results

A total of 55 patients with a median age of 68 years (IQR 61.5–72 years) underwent repeated anatomical pulmonary resection for newly diagnosed second primary NSCLC. Patients' characteristics are presented in Table 1. Twenty‐two patients (40%) presented with a metachronous and 33 patients (60%) a synchronous second NSCLC. Of the 33 patients presenting with synchronous tumors, 11 of them were diagnosed with second primary NSCLC at the time of initial diagnosis (disease‐free interval less than 3 months). Adenocarcinoma was the most common histological subtype in both primary (78.2%) and secondary (76.4%) tumors, followed by squamous cell carcinoma in 20% and 23.6%, respectively (Table 2). Lesions were mostly localized in the upper lobes in both primary and secondary NSCLC (61.8% and 50.9%, respectively). They were ipsilateral in nine cases (14.6%). Pathological TNM staging was not statistically different between first and second NSCLC (p = 0.063). Only one patient had positive parenchymal margins after repeated resection of second NSCLC.

TABLE 1.

Patients' Characteristics and Prior Comorbidities.

	Patients (n = 55)
Sex	28 F / 27 M
Age [years] (median [IQR])	68 [61.5–72]
BMI [kg/m2] (mean ± SD)	26 ± 4.6
High blood pressure	32 (58.2%)
Cardiopathy	14 (25.5%)
Cardiac arrhythmia	2 (3.6%)
LEAD	5 (9.1%)
COPD	24 (43.6%)
Smoking	50 (90.9%)
Diabetes	9 (16.4%)
Renal failure	8 (14.6%)
Immunosuppression	1 (1.8%)
Oncological past	26 (47.3%)
ASA (median [IQR])	3 [2–3]

Abbreviations: ASA: American Society of Anaesthesiologists; BMI: body mass index; COPD: chronic obstructive pulmonary disease; IQR: interquartile range; LEAD: lower extremity artery disease; SD: standard deviation.

TABLE 2.

First and Second NSCLC Characteristics.

	First NSCLC (n = 55)	Second NSCLC (n = 55)	p
Histology			0.278
Adenocarcinoma	43 (78.2%)	42 (76.4%)
Squamous cell carcinoma	11 (20%)	13 (23.6%)
Other	1 (1.8%)	0
Tumor size [mm] (median [IQR])	18 [11.5–27.5]	14 [9–25]	0.059
Localization			0.019
Upper lobe	34 (61.8%)	28 (50.9%)
Lower lobe	16 (29.1%)	26 (47.3%)
Middle lobe	5 (9.1%)	1 (1.8%)
Same lobe		0
Side			0.022
Right	36 (65.5%)	24 (43.6%)
Left	19 (34.5%)	31 (56.4%)
Ipsilateral		9 (16.4%)
Contralateral		46 (83.6%)
TNM staging (8th edition)			0.063
IA1	10 (18.2%)	17 (30.9%)
IA2	20 (36.4%)	16 (29.1%)
IA3	7 (12.7%)	7 (12.7%)
IB	8 (14.5%)	7 (12.7%)
IIA	1 (1.8%)	1 (1.8%)
IIB	6 (10.9%)	3 (5.5%)
IIIA	3 (5.5%)	4 (7.3%)
IIIB	0	0
IIIC	0	0
IV	0	0
R1 resection	0	1 (1.8%)	0.990
DFI [months] (median [IQR])		16 [4–31]
Metachronous		22 (40%)
Synchronous		33 (60%)

Abbreviations: DFI: disease‐free interval; IQR: interquartile range; NSCLC: nonsmall‐cell lung cancer.

Regarding surgical procedures, the VATS approach was performed in 94.5% and 96.4% of first and repeated NSCLC resections, respectively (p = 0.647) (Table 3). Only one case of repeated resection required a conversion thoracotomy due to strong pleural adhesions. The extent of pulmonary resection varied between the first and repeated procedures, with lobectomy being more common in the initial resection (56.4%) and segmentectomy predominating in the repeated resection (85.5%, p < 0.001). Operative time was not statistically different between groups (p = 0.171). The postoperative overall morbidity rate tended to be higher after repeated resection, but this was not statistically significant (23.6% vs. 40%, p = 0.065). However, the rate of cardiac complications (16.4% vs. 0%, atrial fibrillation in all cases) and prolonged air leak (25.5% vs. 5.5%, p = 0.008) was higher after repeated resection. When comparing ipsilateral with contralateral repeated NSCLC resections, the rate of prolonged air leak was not statistically different (44.4% vs. 21.7%, p = 0.164) (Table 4). The rate of redrainage (3.6% vs. 9.1%, p = 0.24) and reoperation (5.5% vs. 7.3%, p = 0.696) were similar between first and repeated resections. Both the median lengths of drainage (1 vs. 2 days, p = 0.065) and of hospital stay (5 vs. 5 days, p = 0.089) were not statistically different after first and repeated resections.

TABLE 3.

First and Repeated NSCLC Resections Characteristics.

	First resection (n = 55)	Repeated resection (n = 55)	p
Pulmonary functions
FEV1 [%] (mean ± SD)	85.5 ± 19.5	81.5 ± 17.2	0.268
DLCO [%] (mean ± SD)	72.5 ± 17.2	68.1 ± 15.3	0.174
Surgical approach			0.647
VATS	52 (94.5%)	53 (96.4%)
Open	3 (5.5%)	2 (3.6%)
Conversion	2 (3.6%)	1 (1.8%)	0.558
Type of resection			< 0.001
Segmentectomy	24 (43.6%)	47 (85.5%)
Lobectomy	29 (52.7%)	8 (14.5%)
Sleeve lobectomy	2 (3.6%)	0
Operative time [minutes] (mean ± SD)	139 ± 50	126 ± 49	0.171
Postoperative complications
–Total	13 (23.6%)	22 (40%)	0.065
–Cardiac (atrial fibrillation)	0	9 (16.4%)	N/A
–Pulmonary	10 (18.2%)	18 (32.7%)	0.080
–Pneumonia	6 (10.9%)	6 (10.9%)	1
–Pleural effusion	1 (1.8%)	0	N/A
–Air leak (> 5 days)	3 (5.5%)	14 (25.5%)	0.008
–Empyema	0	1 (1.8%)	N/A
–Haemothorax	1 (1.8%)	0	N/A
–Chylothorax	0	1 (1.8%)	N/A
–Redrainage	2 (3.6%)	5 (9.1%)	0.241
Length of hospital stay [days] (median [IQR])	5 [3–7]	5 [4–9]	0.089
Length of drainage [days] (median [IQR])	1 [1–3]	2 [1–5]	0.065
Readmission	3 (5.5%)	1 (1.8%)	0.308
Reoperation	3 (5.5%)	4 (7.3%)	0.696

Abbreviations: DLCO: diffusing capacity of the lungs for carbon monoxide; FEV1: forced expiratory volume in one second; IQR: interquartile range; N/A: not applicable; NSCLC: nonsmall‐cell lung cancer; SD: standard deviation; VATS: video‐assisted thoracoscopy.

TABLE 4.

Characteristics of Ipsilateral Second NSCLC.

Patient	First/second NSCLC
	Histology	TNM staging	DFI	Type of resection	Surgical approach	Follow‐up after repeated resection (months)	Recurrence after repeated resection
1	ADC/ADC	IA2/IB	9	Segmentectomy/Segmentectomy	VATS/VATS	57	0
2	ADC/ADC	IIB/IIIA	15	Sleeve lobectomy/Lobectomy	VATS/OT	30	0
3	ADC/ADC	IB/IA1	26	Lobectomy/Segmentectomy	VATS/VATS	38	0
4	SqCC/SqCC	IA3/IA2	4	Lobectomy/Segmentectomy	VATS/VATS	12	0
5	ADC/ADC	IA1/IIIA	15	Lobectomy/Segmentectomy	VATS/VATS	1	0
6	ADC/SqCC	IIB/IA2	17	Lobectomy/Segmentectomy	VATS/VATS	34	0
7	ADC/ADC	IA1/IIB	21	Segmentectomy/Lobectomy	VATS/VATS	4	0
8	SqCC/SqCC	IA1/IA2	43	Segmentectomy/Segmentectomy	VATS/VATS	34	0
9	ADC/ADC	IA3/IIB	36	Lobectomy/Segmentectomy	VATS/VATS	40	0

Abbreviations: ADC: adenocarcinoma; DFI: disease‐free interval; OT: open thoracotomy; SqCC: squamous cell carcinoma; VATS: video‐assisted thoracoscopy.

The median disease‐free interval between first and repeated resections was 16 months (IQR: 4.3–31 months). During the follow‐up from the first resection (median: 47 months; IQR 21–77 months), the 3‐year OS following the initial resection was 73%, whereas the 3‐year OS after repeated resection was 87% (Figure 1). Local disease recurrence was observed in one patient after both first and repeated resections, and distant recurrence was observed only in one patient after repeated resection.

FIGURE 1.

Kaplan–Meier curves of overall survival after first and repeated NSCLC resection. NSCLC: Nonsmall‐cell lung cancer.

4. Discussion

In this study, we present a series of 55 patients who underwent a repeated anatomical pulmonary resection for a newly diagnosed second primary NSCLC. Our findings highlight the feasibility of this approach, as VATS was successfully employed in 96.4% of cases, with segmentectomy predominantly performed in 85.5% of patients. Notably, the repeated surgery proved to be safe even after ipsilateral recurrence, showing comparable rates of conversion to thoracotomy, overall postoperative morbidity, and hospital length of stay to those observed after the initial resection.

The increasing incidence of second primary NSCLC, as demonstrated in recent studies [6, 7], necessitates a thorough evaluation of resection strategies to optimize long‐term survival and perioperative safety. Indeed, performing a repeated pulmonary resection is inherently challenging due to the presence of adhesions, altered anatomical structures, and potential deterioration of pulmonary function. Multiple studies have examined the feasibility and outcomes of such procedures [6, 7, 16, 17, 18, 19, 20, 21, 22]. Muranishi et al. conducted a propensity score‐matched analysis comparing surgery for metachronous primary NSCLC with second primary NSCLC, revealing that postoperative complications (grade II or more) (24% vs. 22%, p = 0.8121) and 5‐year OS (68.7% vs. 83%, p = 0.2018) remained comparable between groups [22]. Their findings align with Sato et al., who demonstrated that careful assessment of functional reserve and tumor characteristics is crucial in determining the suitability of surgical intervention [17].

Given the challenges associated with performing a repeated lobectomy, sublobar resections (segmentectomy or wedge resection) have gained attention as viable alternatives [23]. Several studies have explored the long‐term outcomes of lobar versus sublobar resections of second NSCLC [23]. A meta‐analysis by Zhao et al. including 11 studies with 1131 patients undergoing repeated NSCLC resection highlighted that, in selected patients, sublobar resections offer comparable OS to lobectomy (HR: 0.87, 95% CI: 0.62–1.21, p = 0.41) while preserving pulmonary function [23]. This study was supported by two randomized controlled trials analyzing peripheral stage IA NSCLC and recently published by the Cancer and Leukemia Group B (CALGB) 140 503 [8] and Japanese Cooperative Oncology Group (JCOG) 0802 [9]. Both studies support sublobar resection as a valid alternative to lobectomy in selected patients, offering equivalent survival outcomes with better functional preservation. In the trial by Saji et al., additional intensive resections for second primary NSCLC were more frequently feasible after segmentectomy than lobectomy (89% vs. 63%), highlighting the long‐term benefit of parenchyma‐sparing strategies [9]. In our study, 85.5% of second NSCLC were removed through segmentectomy, which is a higher rate than reported in previous studies (40%–82%) [20, 21, 22]. Unfortunately, we did not analyze functional outcomes after repeated resection in this study.

Similarly, technical improvements in surgical approach, now mainly dominated by VATS, facilitate repeated resections and improve patient recovery [10, 11]. Indeed, several studies demonstrated the advantages on postoperative morbidity after lobectomy for NSCLC of the VATS approach over open thoracotomy [10, 11]. A recent study investigated the feasibility of repeated VATS for ipsilateral lung cancer, finding that minimally invasive techniques could be safely applied and significantly reduce morbidity compared to open surgery [20]. In our study, 96.4% of procedures were performed by VATS with only one patient requiring conversion to thoracotomy during repeated resection because of adhesions. This rate, lower than those reported in other studies [20, 21], might be explained by a careful patient selection for surgery and a highly experienced surgical team when it comes to performing VATS anatomical pulmonary resections.

Postoperative morbidity is a key concern, particularly in patients with prior ipsilateral resections and potentially compromised pulmonary reserve [7, 16, 21]. In our series, the overall postoperative morbidity rate following the repeated resection reached 40%, compared to 23.6% after the first surgery, a difference that did not reach statistical significance (p = 0.065), potentially due to the size of our cohort. This morbidity rate is consistent with previous reports, such as the one from Abid et al., who reported an overall morbidity of 36.5% after repeated NSCLC resection [21]. In our cohort, the incidence of cardiac complications (16.4% vs. 0%) and prolonged air leak (25.5% vs. 5.5%, p = 0.008) was significantly higher following repeated resections, suggesting greater physiological strain and potentially compromised parenchymal integrity. Moreover, segmentectomies were performed more frequently during repeated procedures, thus increasing the risk of air leak due to intersegmental plane dissection. Notably, prolonged air leaks occurred more frequently after ipsilateral compared to contralateral procedures, but this was not statistically significant (44.4% vs. 21.7%, p = 0.164). Several studies have highlighted increased postoperative risk associated with ipsilateral anatomical resections for metachronous NSCLC. Soro‐García et al. reported significantly higher rates of prolonged air leaks (p = 0.037) and postoperative arrhythmias (p = 0.019) after ipsilateral compared to contralateral surgery [16]. Similarly, Okazaki et al. observed elevated complication rates following ipsilateral resections, reflecting the technical complexity of operating in previously manipulated fields [7]. This highlights the need for careful preoperative cardiopulmonary functional assessment and perioperative careful parenchymal management (e.g., using sealants or techniques to mitigate prolonged air leak in reoperations).

Nevertheless, despite the higher morbidity, the overall safety in our series remains acceptable. Rates of reoperation (7.3% vs. 5.5%) and chest tube reinsertion (9.1% vs. 3.6%) were similar between first and repeated procedures, suggesting no significant increase in severe complications. Finally, while morbidity tends to be higher following a repeated resection, the impact on short‐term recovery in your cohort was limited. Both median chest tube duration (2 vs. 1 day, p = 0.065) and median hospital stay (5 days for both, p = 0.089) were similar between the two procedures.

As demonstrated by several studies analyzing oncological outcomes after surgical resection of early‐stage NSCLC [8, 9], our study found a 3‐year OS of 73% after first and 87% after repeated NSCLC resection. Similar to our results, a propensity score‐matched study including 50 patients with repeated NSCLC surgery demonstrated a 5‐year OS of 68.7% and 83% in the first and repeated resection groups, respectively (p = 0.202) [22]. Another study by Okazaki and colleagues revealed a 5‐year OS of 83.5% after ipsilateral lobectomy for a second NSCLC in patients with previous anatomical resection [7]. These results were aligned with those of Abid et al. who showed a 5‐year OS estimate of 87.1% in their cohort of 52 patients undergoing resection of second NSCLC [21]. Given that OS is not compromised following reresection for a second primary NSCLC, surgery remains a valuable therapeutic option with demonstrable benefits for selected patients. However, careful patient selection remains essential to optimize outcomes.

Despite the valuable insights provided, our study has several limitations. First, its retrospective nature may introduce selection and information biases. Second, the relatively small sample size limits the generalizability of our findings. Additionally, all procedures were performed at a single center, which may not reflect outcomes in other surgical settings. We did not performed subgroups analyses of ipsilateral procedures, thus limiting the generalization of our postoperative results. We did not include patients treated by other modalities than anatomical resection (wedge resection, stereotactic body radiation therapy [SBRT], others). Finally, the follow‐up period may not have been sufficient to assess long‐term functional outcomes and disease recurrence comprehensively.

In conclusion, repeated anatomical pulmonary resection for second primary NSCLC, even if it is ipsilateral, appears safe with acceptable morbidity and promising short‐term survival. High rates of VATS segmentectomy suggest that, in experienced centers, parenchymal‐sparing procedures are secure and may preserve lung function in carefully selected patients.

Author Contributions

Conceptualization: C.F., M.G. Data curation: C.F., M.G. Formal analysis: C.F., L.E.C., M.G. Investigation: C.F., M.G. Methodology: C.F., M.G. Project administration: C.F., M.G. Resources: C.F., M.G. Supervision: C.F., M.G. Validation: C.F., M.G. Visualization: C.F., M.G. Writing – original draft preparation: C.F., M.G. Writing – review and editing: All authors.

Disclosure

The authors have nothing to report.

Ethics Statement

This study was approved by the local ethics committee (CER‐VD in Lausanne, Switzerland) (referral number: (N°2024_02079)).

Consent

An informed consent was obtained from all patients.

Conflicts of Interest

The authors declare no conflicts of interest.

Forster C., Chriqui L.-E., Abdelnour‐Berchtold E., et al., “Repeated Anatomical Pulmonary Resection for Second Primary Nonsmall‐Cell Lung Cancer: Safety and Short‐Term Outcomes,” Thoracic Cancer 16, no. 12 (2025): e70116, 10.1111/1759-7714.70116.

Data Availability Statement

The data underlying this article will be shared on reasonable request to the corresponding author.