title: Risk associated with bilobectomy after neoadjuvant concurrent chemoradiotherapy for stage IIIA-N2 non-small-cell lung cancer.
abstract: BACKGROUND
  The aim of the present study was to evaluate the outcomes of surgical resection, especially bilobectomy, after chemoradiation therapy to treat stage IIIA-N2 non-small-cell lung cancer.
  
  
  METHODS
  Data from all patients who underwent surgical resection after neoadjuvant chemoradiation therapy for stage IIIA-N2 non-small-cell lung cancer between 1998 and 2007 were analyzed retrospectively. The chemotherapy regimen consisted of weekly paclitaxel plus cisplatin or weekly paclitaxel plus carboplatin for 5 weeks. The concurrent thoracic radiotherapy dose was 45 Gy over 5 weeks. Surgical resection was planned at around 4 weeks following the completion of neoadjuvant therapy.
  
  
  RESULTS
  Of 186 patients who underwent neoadjuvant therapy, 23 bilobectomies, 28 pneumonectomies, and 135 lobectomies were performed. The early postoperative mortality rate (within 30 days after operation) was 7.1, 8.7, and 1.5% for the pneumonectomy, bilobectomy, and lobectomy groups, respectively. The late postoperative mortality rate (within 90 days) of the lobectomy, bilobectomy, and pneumonectomy groups was 5.9, 13, and 10.7%, respectively. Overall survival was significantly higher among patients treated by lobectomy than among those treated by bilobectomy (p = 0.041) or pneumonectomy (p = 0.010). Recurrence was significantly lower in patients treated by lobectomy than in those treated by pneumonectomy (p = 0.034).
  
  
  CONCLUSIONS
  Bilobectomy is associated with high operative mortality and poor long-term survival after neoadjuvant concurrent chemoradiotherapy for stage IIIA-N2 non-small-cell lung cancer. The outcomes of bilobectomy were similar to those of pneumonectomy in terms of overall survival, disease-free survival, and postoperative mortality.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Seoul, Korea.
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
authors.forename: Jhingook
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
authors.forename: Kwhanmien
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
authors.forename: Young Mog
authors.initials: YM
authors.lastname: Shim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
authors.forename: Hong Kwan
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, 135-710, Korea. choi.smcts@gmail.com.
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols; D016190:Carboplatin / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000627:therapeutic use; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin