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Ann Thorac Surg 1995;60:640-645
© 1995 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Are Bilobectomies Acceptable Procedures?

Department of Thoracic Surgery, University Hospital of Strasbourg, Strasbourg, France

Accepted for publication April 5, 1995.

Background. Controversy about operative morbidity and oncologic value of bilobectomy has led to a review of our experience over the past 12 years.

Methods. The charts of 112 patients (100 men and 12 women with a mean age of 63 years) were reviewed for operative mortality and morbidity and long-term survival. Survival of patients with stage I or stage II disease was compared with that of stage-matched and age-matched groups having right pneumonectomy.

Results. Four patients (3.5%) died postoperatively. Nonfatal complications occurred in 55 patients (49%); the most frequent problem was pleural space disease (34%). Survival studies focused on the 96 patients with non–small cell bronchogenic cancer (44 in stage I, 32 in stage II, and 20 in stage IIIA). The overall 5-year survival rate was 40%; the 5-year survival rate was similar for stage I and stage II (41% for stage I, 50% for stage II, and 17% for stage IIIA). The incidence of local recurrence was significantly increased after bilobectomy for stage I cancer (² = 5.066; p lt; 0.05) compared with pneumonectomy but did not affect 5-year survival. Local recurrence and survival were similar after bilobectomy and pneumonectomy in stage II.

Conclusions. These data demonstrate an increased morbidity after bilobectomy. Survival studies demonstrate an increased risk of local recurrence in patients with stage I disease, which might be partly explained by understaging.

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Invited Commentary

Jean-Francois Regnard
Ann. Thorac. Surg. 1995 60: 645. [Extract] [Full Text]

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