The place for bilobectomy in bronchogenic carcinoma.
From 1978 to 1988, 148 bilobectomies (21 upper and middle and 127 lower and middle) were performed for bronchogenic carcinoma. A conservative procedure was mandatory in 29 patients in whom a pneumonectomy was not functionally feasible while bilobectomy was deliberately performed in 119 patients with near normal lung function. Overall mortality was 6% compared to 4% and 3%, respectively, following pneumonectomies and lobectomies. Preoperative functional status did not significantly influence mortality. The complication rate was 55%. The incidence of bronchopleural fistula electively observed after lower and middle lobe resection was significantly higher (11%) compared to 4% after pneumonectomy and 1.4% after lobectomy (P less than 0.01). The overall 5-year survival was 43% and was similar to that observed at comparable TNM stage after other pulmonary resections. Residual right pulmonary function demonstrated by perfusion isotopic scan was 24% +/- 10 in 21 long-term survivors. These results indicate that bilobectomy can reasonably be considered in patients requiring more than a lobectomy but in whom lung conservation is mandatory despite a significant increase in morbidity. The risk appears justifiable regarding late survival results and functional benefit of the remaining right lobe.
Deneuville
M
M
Department of Thoracic and Vascular Surgery, Centre Chirurgical Marie Lannelongue, University Paris-Sud, France.
Régnard
J F
JF
Coggia
M
M
Rojas-Miranda
A
A
Dartevelle
P
P
Levasseur
P
P
D000368:Aged; D002283:Carcinoma, Bronchogenic / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000601:surgery; D008175:Lung Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D015996:Survival Rate; D013997:Time Factors