Bilobectomy for lung cancer: Analysis of indications, postoperative results, and long-term outcomes

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Abstract

Bilobectomy for lung cancer is considered a high-risk procedure for the increased postoperative complication rate and the negative impact on survival. We analyzed the safety and the oncologic results of this procedure. We retrospectively reviewed patients who underwent bilobectomy for lung cancer between October 1998 and August 2009. Age, gender, bilobectomy type and indication, complications, pathology, stage, and survival were analyzed. Bilobectomy was performed on 146 patients (101 men; mean age, 62 years). There were 77 upper-middle and 69 middle-lower bilobectomies. Indications were tumor extending across the fissure in 27 (18.5%) patients, endobronchial tumor in 39 (26.7%), extrinsic tumor or nodal invasion of bronchus intermedius in 66 (45.2%), and vascular invasion in 14 (9.6%). An extended resection was performed in 24 patients (16.4%). Induction therapy was performed in 43 patients (29.4%). Thirty-day mortality was 1.4% (n = 2). Overall morbidity was 47.2%. Mean chest tube persistence was 7 days (range, 6 to 46 days). Overall 5-year survival was 58%. Significance differences in survival were observed among different stages (stage I, 70%; stage II, 55%; stage III, 40%; p = 0.0003) and the N status (N0, 69%; N1, 56%; N2, 40%; p = 0.0005). Extended procedure (p = 0.0003) and superior bilobectomy (p = 0.0008) adversely influenced survival. Multivariate analysis demonstrated that an extended resection (p = 0.01), an advanced N disease (p = 0.02), and an upper-mild lobectomy (p = 0.02) adversely affected prognosis. Bilobectomy is associated with a low mortality and an increased morbidity. Survival relates to disease stage and N factor. Optimal prognosis is obtained in patients with lower-middle lobectomy without extension of the resection.

Original languageEnglish
Pages (from-to)251-258
Number of pages8
JournalAnnals of Thoracic Surgery
Volume93
Issue number1
DOIs
Publication statusPublished - Jan 2012

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Lung Neoplasms
Survival
Morbidity
Chest Tubes
Neoplasms
Mortality
Bronchi
Blood Vessels
Multivariate Analysis
Pathology
Safety
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

@article{d716594161f543b7a917aae702378ce1,
title = "Bilobectomy for lung cancer: Analysis of indications, postoperative results, and long-term outcomes",
abstract = "Bilobectomy for lung cancer is considered a high-risk procedure for the increased postoperative complication rate and the negative impact on survival. We analyzed the safety and the oncologic results of this procedure. We retrospectively reviewed patients who underwent bilobectomy for lung cancer between October 1998 and August 2009. Age, gender, bilobectomy type and indication, complications, pathology, stage, and survival were analyzed. Bilobectomy was performed on 146 patients (101 men; mean age, 62 years). There were 77 upper-middle and 69 middle-lower bilobectomies. Indications were tumor extending across the fissure in 27 (18.5{\%}) patients, endobronchial tumor in 39 (26.7{\%}), extrinsic tumor or nodal invasion of bronchus intermedius in 66 (45.2{\%}), and vascular invasion in 14 (9.6{\%}). An extended resection was performed in 24 patients (16.4{\%}). Induction therapy was performed in 43 patients (29.4{\%}). Thirty-day mortality was 1.4{\%} (n = 2). Overall morbidity was 47.2{\%}. Mean chest tube persistence was 7 days (range, 6 to 46 days). Overall 5-year survival was 58{\%}. Significance differences in survival were observed among different stages (stage I, 70{\%}; stage II, 55{\%}; stage III, 40{\%}; p = 0.0003) and the N status (N0, 69{\%}; N1, 56{\%}; N2, 40{\%}; p = 0.0005). Extended procedure (p = 0.0003) and superior bilobectomy (p = 0.0008) adversely influenced survival. Multivariate analysis demonstrated that an extended resection (p = 0.01), an advanced N disease (p = 0.02), and an upper-mild lobectomy (p = 0.02) adversely affected prognosis. Bilobectomy is associated with a low mortality and an increased morbidity. Survival relates to disease stage and N factor. Optimal prognosis is obtained in patients with lower-middle lobectomy without extension of the resection.",
author = "Domenico Galetta and Piergiorgio Solli and Alessandro Borri and Francesco Petrella and Roberto Gasparri and Daniela Brambilla and Lorenzo Spaggiari",
year = "2012",
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T1 - Bilobectomy for lung cancer

T2 - Analysis of indications, postoperative results, and long-term outcomes

AU - Galetta, Domenico

AU - Solli, Piergiorgio

AU - Borri, Alessandro

AU - Petrella, Francesco

AU - Gasparri, Roberto

AU - Brambilla, Daniela

AU - Spaggiari, Lorenzo

PY - 2012/1

Y1 - 2012/1

N2 - Bilobectomy for lung cancer is considered a high-risk procedure for the increased postoperative complication rate and the negative impact on survival. We analyzed the safety and the oncologic results of this procedure. We retrospectively reviewed patients who underwent bilobectomy for lung cancer between October 1998 and August 2009. Age, gender, bilobectomy type and indication, complications, pathology, stage, and survival were analyzed. Bilobectomy was performed on 146 patients (101 men; mean age, 62 years). There were 77 upper-middle and 69 middle-lower bilobectomies. Indications were tumor extending across the fissure in 27 (18.5%) patients, endobronchial tumor in 39 (26.7%), extrinsic tumor or nodal invasion of bronchus intermedius in 66 (45.2%), and vascular invasion in 14 (9.6%). An extended resection was performed in 24 patients (16.4%). Induction therapy was performed in 43 patients (29.4%). Thirty-day mortality was 1.4% (n = 2). Overall morbidity was 47.2%. Mean chest tube persistence was 7 days (range, 6 to 46 days). Overall 5-year survival was 58%. Significance differences in survival were observed among different stages (stage I, 70%; stage II, 55%; stage III, 40%; p = 0.0003) and the N status (N0, 69%; N1, 56%; N2, 40%; p = 0.0005). Extended procedure (p = 0.0003) and superior bilobectomy (p = 0.0008) adversely influenced survival. Multivariate analysis demonstrated that an extended resection (p = 0.01), an advanced N disease (p = 0.02), and an upper-mild lobectomy (p = 0.02) adversely affected prognosis. Bilobectomy is associated with a low mortality and an increased morbidity. Survival relates to disease stage and N factor. Optimal prognosis is obtained in patients with lower-middle lobectomy without extension of the resection.

AB - Bilobectomy for lung cancer is considered a high-risk procedure for the increased postoperative complication rate and the negative impact on survival. We analyzed the safety and the oncologic results of this procedure. We retrospectively reviewed patients who underwent bilobectomy for lung cancer between October 1998 and August 2009. Age, gender, bilobectomy type and indication, complications, pathology, stage, and survival were analyzed. Bilobectomy was performed on 146 patients (101 men; mean age, 62 years). There were 77 upper-middle and 69 middle-lower bilobectomies. Indications were tumor extending across the fissure in 27 (18.5%) patients, endobronchial tumor in 39 (26.7%), extrinsic tumor or nodal invasion of bronchus intermedius in 66 (45.2%), and vascular invasion in 14 (9.6%). An extended resection was performed in 24 patients (16.4%). Induction therapy was performed in 43 patients (29.4%). Thirty-day mortality was 1.4% (n = 2). Overall morbidity was 47.2%. Mean chest tube persistence was 7 days (range, 6 to 46 days). Overall 5-year survival was 58%. Significance differences in survival were observed among different stages (stage I, 70%; stage II, 55%; stage III, 40%; p = 0.0003) and the N status (N0, 69%; N1, 56%; N2, 40%; p = 0.0005). Extended procedure (p = 0.0003) and superior bilobectomy (p = 0.0008) adversely influenced survival. Multivariate analysis demonstrated that an extended resection (p = 0.01), an advanced N disease (p = 0.02), and an upper-mild lobectomy (p = 0.02) adversely affected prognosis. Bilobectomy is associated with a low mortality and an increased morbidity. Survival relates to disease stage and N factor. Optimal prognosis is obtained in patients with lower-middle lobectomy without extension of the resection.

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