title: Bilobectomy Versus Lobectomy for Non-Small Cell Lung Cancer: A Comparative Study of Outcomes, Long-Term Survival, and Quality of Life.
abstract: BACKGROUND
  We aimed to compare long-term survival and quality of life (QOL) outcomes after bilobectomy and lobectomy for non-small cell lung cancer patients.
  
  
  METHODS
  A cohort of 951 consecutive patients was identified from a single treatment institution, of whom 128 underwent bilobectomy and 823, lobectomy. Propensity score matching (1:3) was applied to balance known confounders between the two surgical groups and resulted in 512 patients (matched cohort). Unmatched and matched analyses were performed to compare clinical outcomes between the two groups, including operative mortality rate, morbidity rate, long-term survival, overall QOL, and specific symptoms.
  
  
  RESULTS
  Operative mortality was higher in the bilobectomy group than in the lobectomy group (2.3% versus 0.5%, p = 0.022). Morbidity rates did not differ significantly between the two groups in either unmatched or matched cohort. In the unmatched analysis, the overall survival (OS [p = 0.003]) and disease-free survival (DFS [p = 0.003]) were significantly lower in the bilobectomy group; whereas in the matched analysis, no significant difference was found in either OS (p = 0.473) or DFS (p = 0.387). Using multivariate analysis, the operation type was not found to be a significant factor for either OS (hazard ratio 1.18; 95% confidence interval: 0.91 to 1.52; p = 0.22) or DFS (hazard ratio 1.22; 95% confidence interval: 0.95 to 1.58; p = 0.13). Patients who underwent bilobectomy appeared to have similar measures of QOL as lobectomy patients, except for coughing and dyspnea.
  
  
  CONCLUSIONS
  Our findings indicate that patients with non-small cell lung cancer treated with bilobectomy had similar morbidity, OS, DFS, and overall QOL as patients treated with lobectomy, but had higher mortality by matched analysis.
authors.affiliation: Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Xie
authors.affiliation: Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
authors.affiliation: Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Shen
authors.affiliation: Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Bo
authors.initials: B
authors.lastname: Deng
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Wampfler
authors.affiliation: Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cassivi
authors.affiliation: Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Francis C
authors.initials: FC
authors.lastname: Nichols
authors.affiliation: Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.affiliation: Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wigle
authors.affiliation: Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota. Electronic address: yang.ping@mayo.edu.
authors.forename: Ping
authors.initials: P
authors.lastname: Yang
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D011013:Pneumonectomy / Q000379:methods*; D011788:Quality of Life; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome