title: Bilobectomy for lung cancer: analysis of indications, postoperative results, and long-term outcomes.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy. mimgaletta@yahoo.com
authors: Domenico
authors: D
authors: Galetta
authors: Piergiorgio
authors: P
authors: Solli
authors: Alessandro
authors: A
authors: Borri
authors: Francesco
authors: F
authors: Petrella
authors: Roberto
authors: R
authors: Gasparri
authors: Daniela
authors: D
authors: Brambilla
authors: Lorenzo
authors: L
authors: Spaggiari
mesh_terms: D001706:Biopsy; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome