PURPOSE: The resection of two lobes for non-small cell lung cancer (NSCLC) has the potential for significant morbidity and mortality as well as a negative impact on survival. The purpose of this study is to analyze our bilobectomy experience.
METHODS: Age, gender, diagnosis, bilobectomy type, bilobectomy indication, operative technique, pathology, major complications, stage and survival were reviewed from 1984–2007. Kaplan-Meier survival curves were compared by Log-rank and likelihood ratio analysis.
RESULTS: Bilobectomies were performed on 115 patients with 92 having NSCLC (45 adenocarcinoma [ADC], 39 squamous carcinomas [SQC], 8 others). An additional 23 patients had neuroendocrine carcinoma (8), metastatic carcinoma (8), and benign disease (6), but were excluded from the analysis. For NSCLC, there were 35 upper-middle (UM) and 57 middle-lower (ML) bilobectomies performed. Indications for bilobectomy included bronchial involvement (44), extension across the fissure (36), or other reasons (7). Major complications included pneumonia or retained secretion requiring intervention (21/92), supraventricular tachyarrhythmia (11/92), prolonged air-leak (8/92), stump-related bronchopleural fistula (3/92), empyema (3/92), ARDS (2/92), thromboembolic complications (2/92), stroke (2/92), chylothorax (1/92), myocardial infarction (1/92), and recurrent laryngeal nerve injury (1/92). There were 4 (4.3%) deaths from pneumonia, empyema, ARDS, and pulmonary embolus. Five-year survival for all patients was 42%. Significant differences in survival were observed among the different stages (stage I −66%, stage II –42%, stage III –13%, p<0.0001).SQCs had a higher 5-year survival than ADCs (54% vs. 32%) that approached significance by log rank (p<0.079) and reached significance by likelihood ratios (p<0.048). When bilobectomy was performed for bronchial involvement, no differences in survival between ADC and SQC were observed. However, when bilobectomy was performed for extension across the fissure, survival approached significance for SQC over ADC by log rank (p<0.090) and was significant by likelihood ratio (p<.048) when comparing survival between ADC and SQC.
CONCLUSION: Bilobectomy can be performed with acceptable morbidity and mortality. Survival relates to disease stage.
CLINICAL IMPLICATIONS: Optimal survival benefit occurs when the indication for bilobectomy is SQC extending across the fissure.
DISCLOSURE: Anthony Kim, No Financial Disclosure Information; No Product/Research Disclosure Information