DISCUSSION
Synchronous tumors are a challenge to surgeons because concomitant
surgeries may be required, potentially resulting in prolonged surgery
time and postoperative hospitalization. However, two-stage surgery may
involve a risk of malignant disease progression. Kurul et al. reported
the case of a 56-year-old female who suffered from triple primary tumors
of the breast, non-small cell cancer, and melanoma.4The patient underwent concomitant mastectomy and melanoma excision;
stereotactic radiotherapy for lung cancer was performed thereafter.
Stereotactic radiotherapy resulted in a few complications and controlled
the lung cancer; hence, a two-stage operation was performed.
In the present case, a huge mass originating from the ovary developed;
this indicates a potentially longer operation time. To the best of our
knowledge, breast cancer and synchronous lung cancer with such huge
primary mucinous cystadenoma treated with concomitant surgery have never
been reported previously. Regarding operation for multiple cancers,
Shoji et al. reported the safety and feasibility of concomitant
operation of breast cancer and synchronous lung
cancer.5 We initially considered performing radical
mastectomy concomitant with video-assisted thoracic surgery (VATS) wedge
resection for possible malignant tumor and tumor metastases prevention.
After a discussion with a thoracic surgeon, gynecologist, and the
patient, we decided to perform concomitant surgery due to the following
reasons: First, the patient’s condition was stable, without systemic
disease, and an Eastern Cooperative Oncology Group score of 0. Second,
each surgery requires about 60–90 minutes, and we expected that the
concomitant surgery could be completed within 4 hours. The risk of
prolonged general anesthesia time is relatively low and was considered
acceptable in this case. Third, the patient had to receive adjuvant
chemotherapy for breast cancer, which might have an impact on the
subsequent surgery. Thereafter, we performed VATS with wedge resection
first due to the right lateral operative position. Radical mastectomy
and debulking surgery were performed concurrently with the patient
positioned supine. The surgery was completed uneventfully within 4 hours
as expected, and adjuvant chemotherapy for breast cancer was prescribed
thereafter. A case study reported that synchronous tumors of the ovary
and endometrium are tumors with a good prognosis, especially in the
early stages. The 5-year and 10-year survival rates were reportedly
85.9% and 80.3%, respectively, and the survival rate depends on the
FIGO stage, the tumor’s histology, and its association with adjuvant
treatment.6 Moreover, we arranged adjuvant treatment
to achieve better outcomes.
In conclusion, we demonstrated a successful concomitant operation for
triple primary tumors, which has never been reported. Six months after
treatment, the patient was active, and no tumor recurrence was reported.
Multiple primary malignant tumors present a challenge when developing
therapeutic plans. Concomitant surgery requires comprehensive
preoperative evaluation and discussion with other specialists.