title: Bilobectomy for lung cancer: contemporary national early morbidity and mortality outcomes.
abstract: OBJECTIVE
  To determine contemporary early outcomes associated with bilobectomy for lung cancer and to identify their predictors using a nationally representative general thoracic surgery database.
  
  
  METHODS
  A total of 1831 patients, who underwent elective bilobectomy for primary lung cancer between 1 January 2004 and 31 December 2013, were selected. Logistic regression analysis was performed on variables for major adverse events.
  
  
  RESULTS
  There were 670 upper and 1161 lower bilobectomies. Video-assisted thoracic surgery was seldom performed (2%). Induction therapy and extended resection were performed in 293 (16%) and 279 patients (15.2%), respectively. Operative mortality was 4.8% (upper: 4.5%/lower: 5%; P = 0.62), and significantly higher following extended procedures when compared with standard bilobectomy (4.3 vs 7.5%; P = 0.013). Pulmonary complication rate was 21.1%. Bronchial fistula occurred in 46 patients (2.5%) and pleural space complications in 296 (16.2%). Their respective incidence rates were significantly higher following lower than upper bilobectomy (3.5 vs 0.7%; P < 0.001 and 17.8 vs 13.3%; P = 0.007). At multivariate analysis, extended procedures [odds ratio (OR), 2.3; 95% confidence interval (CI), 1.03-5.31; P = 0.04], ASA scores of 3 or greater (OR, 2.02; 95% CI, 1.33-3.07; P < 0.001) and World Health Organization performance status 2 or greater (OR, 1.47; 95% CI, 1.01-2.13; P = 0.04) were risk predictors of mortality. Female gender (OR, 0.39; 95% CI, 0.19-0.80; P = 0.01), highest body mass index (BMI) values (OR, 0.91; 95% CI, 0.86-0.96; P = 0.001) and recent years of surgery (OR, 0.91; 95% CI, 0.84-0.99; P = 0.02) were protective. Predictors of bronchial fistula were male gender, lowest BMI values, lower bilobectomy and longest operative times. Male gender, lowest BMI values and longest operative times were also predictors of pulmonary complications, together with highest ASA scores and lowest forced expiratory volume in 1 s values.
  
  
  CONCLUSIONS
  Risks related to lower bilobectomy lie halfway between those reported for lobectomy and pneumonectomy. Additional surgical measures to prevent pleural space complications and bronchial fistula should be encouraged with this operation. In contrast, upper bilobectomy shares more or less the same hazards as lobectomy.
authors.affiliation: Department of Thoracic Surgery, Hôpital Nord-APHM, Aix-Marseille University, Marseille, France pathomas@ap-hm.fr.
authors.forename: Pascal A
authors.initials: PA
authors.lastname: Thomas
authors.affiliation: Department of Thoracic Surgery, NHC, CHU de Strasbourg, Strasbourg, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Falcoz
authors.affiliation: Department of Thoracic Surgery, Hôpital du Bocage, CHU Dijon-Bourgogne, Dijon, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Bernard
authors.affiliation: Department of Thoracic Surgery, HEGP-APHP, Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Le Pimpec-Barthes
authors.affiliation: Department of Thoracic Surgery, Hôpital Haut Lévêque, CHU de Bordeaux, Bordeaux, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Jougon
authors.affiliation: Department of Thoracic Surgery, Hôpital Larrey, CHU de Toulouse, Toulouse, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brouchet
authors.affiliation: Department of Thoracic Surgery, NHC, CHU de Strasbourg, Strasbourg, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Massard
authors.affiliation: Department of Thoracic Surgery, Hôpital Larrey, CHU de Toulouse, Toulouse, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Dahan
authors.affiliation: Methodological Assistance to Clinical Research, Department of Public Health, Faculty of Medicine, Marseille, France.
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
mesh_terms: D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000209:etiology / Q000401:mortality; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010995:Pleural Diseases / Q000209:etiology / Q000401:mortality; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011446:Prospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome
keywords: Non-small-cell lung carcinoma; Surgery; Treatment outcome