title: Does bilobectomy offer satisfactory long-term survival outcome for non-small cell lung cancer?
abstract: BACKGROUND
  Results of bilobectomy for non-small cell lung cancer have rarely been studied.
  
  
  METHODS
  Retrospective analysis was conducted on patients with non-small cell lung cancer having undergone bilobectomy from January 1999 to June 2012 at our institution. Analysis aimed at determining perioperative mortality and morbidity, and at studying prognostic factors for long-term survival using the 7th TNM classification.
  
  
  RESULTS
  A total of 103 patients (85 males; mean age 62 years) underwent upper-middle bilobectomy (n = 54) or lower-middle bilobectomy (n = 49). Histologic examination revealed 51 adenocarcinomas, 43 squamous cell carcinomas and 9 other cell carcinomas. Perioperative mortality was 0.97%. The overall morbidity rate was 71%, whereas the rate of life-threatening complications was 9.6%. Complications were more frequent in men (p = 0.032), in patients with chronic pulmonary obstructive diseases (p = 0.030) and after lower-middle bilobectomy (p = 0.0016). The overall 5-year Kaplan-Meier survival rate was 57.8%. In univariate analysis, factors associated with increased survival were the following: pathologic stage (stage I 74.9%, stage II 64.1%, stage III 28.8%, p = 0.0018); nodal status (N0 vs N1, p = 0.011; N0 vs N2, p = 0.0015; N0 vs N+, p = 0.0008); R status (R0 vs R1, p = 0.0032), and smoking status (past smoker or nonsmoker vs active smoker, p = 0.00054). Multivariate analysis revealed that active smokers (RR = 3.87, CI 95% [1.83 to 8.21]; p = 0.00042) and increasing stage (stage 0: RR=1; stage I: RR = 1.98, CI 95% [1.38 to 2.83]; stage II: RR = 3.90, CI 95% [1.90 to 8.02]; stage III: RR=7.72, CI 95% [2.62 to 22.73]; stage IV: RR = 15.25, CI 95% [3.61 to 64.40]; p = 0.0042) were significantly associated with poorer survival.
  
  
  CONCLUSIONS
  Bilobectomy can be performed with low mortality, acceptable morbidity and long term survival in accordance with TNM staging.
authors.affiliation: Department of Thoracic Surgery, University Hospital of Caen, Caen, France. icard-p@chu-caen.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Icard
authors.forename: Maxime
authors.initials: M
authors.lastname: Heyndrickx
authors.forename: Françoise
authors.initials: F
authors.lastname: Galateau-Sallé
authors.forename: Paul
authors.initials: P
authors.lastname: Rosat
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Lerochais
authors.forename: Radj
authors.initials: R
authors.lastname: Gervais
authors.forename: Gerard
authors.initials: G
authors.lastname: Zalcman
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Hanouz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015505:Chest Tubes; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology