Original article
General thoracic
Does Bilobectomy Offer Satisfactory Long-Term Survival Outcome for Non-Small Cell Lung Cancer?

https://doi.org/10.1016/j.athoracsur.2013.01.071Get rights and content

Background

Results of bilobectomy for non-small cell lung cancer have rarely been studied.

Methods

Retrospective analysis was conducted on patients with non-small cell lung cancer having undergone bilobectomy from January 1999 to June 2012 at our institution. Analysis aimed at determining perioperative mortality and morbidity, and at studying prognostic factors for long-term survival using the 7th TNM classification.

Results

A total of 103 patients (85 males; mean age 62 years) underwent upper-middle bilobectomy (n = 54) or lower-middle bilobectomy (n = 49). Histologic examination revealed 51 adenocarcinomas, 43 squamous cell carcinomas and 9 other cell carcinomas. Perioperative mortality was 0.97%. The overall morbidity rate was 71%, whereas the rate of life-threatening complications was 9.6%. Complications were more frequent in men (p = 0.032), in patients with chronic pulmonary obstructive diseases (p = 0.030) and after lower-middle bilobectomy (p = 0.0016). The overall 5-year Kaplan-Meier survival rate was 57.8%. In univariate analysis, factors associated with increased survival were the following: pathologic stage (stage I 74.9%, stage II 64.1%, stage III 28.8%, p = 0.0018); nodal status (N0 vs N1, p = 0.011; N0 vs N2, p = 0.0015; N0 vs N+, p = 0.0008); R status (R0 vs R1, p = 0.0032), and smoking status (past smoker or nonsmoker vs active smoker, p = 0.00054). Multivariate analysis revealed that active smokers (RR = 3.87, CI 95% [1.83 to 8.21]; p = 0.00042) and increasing stage (stage 0: RR=1; stage I: RR = 1.98, CI 95% [1.38 to 2.83]; stage II: RR = 3.90, CI 95% [1.90 to 8.02]; stage III: RR=7.72, CI 95% [2.62 to 22.73]; stage IV: RR = 15.25, CI 95% [3.61 to 64.40]; p = 0.0042) were significantly associated with poorer survival.

Conclusions

Bilobectomy can be performed with low mortality, acceptable morbidity and long term survival in accordance with TNM staging.

Section snippets

Data Collection

Retrospective analysis was performed on patients with non-small cell lung cancer having undergone bilobectomy from January 1999 to June 2012 at our institution (Department of Thoracic Surgery, University Hospital of Caen, France). Institutional Review Board approval was obtained to perform this retrospective investigation. The following were recorded: age, gender, American Society of Anesthesiologists score, body mass index (in kg/m²), forced expiratory volume in 1 second (FEV1), type of

Patient Characteristics

Bilobectomies were performed on 85 male and 18 female patients, of a mean age of 61.9 years (range 43 to 82 years). Comorbidity factors are listed in Table 1. Surgical indications are presented in Table 2. Fifty-four upper-middle bilobectomies (including 2 sleeve resections) and 49 lower-middle bilobectomies were performed. Neoadjuvant chemotherapy was performed in 26 patients. Twenty-five patients had COPD. A total of 74 bronchial stumps were closed automatically by staples and 29 manually by

Comment

After the first bilobectomy performed by Churchill in 1933 [12], the first series were not published until the 1990s 4, 5. Since then, the postoperative course of this resection has generally been considered as intermediate between lobectomy and pneumonectomy.

Cited by (8)

  • Bilobectomy Versus Lobectomy for Non-Small Cell Lung Cancer: A Comparative Study of Outcomes, Long-Term Survival, and Quality of Life

    2015, Annals of Thoracic Surgery
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    In the current analysis, we found that no survival differences were observed when comparing types of bilobectomy (MLG versus UMG). That is similar to the report of Icard and colleagues [5]. Although the present study was specifically designed to minimize selection bias of confounders through propensity score-matched analysis, several potential limitations remain.

  • Invited Commentary

    2015, Annals of Thoracic Surgery
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