Bilobectomy for non-small cell lung cancer: A search for clinical factors that may affect perioperative morbidity and long-term survival

Objective: The resection of two lobes for non-small cell lung cancer has the potential for significant morbidity and mortality as well as a negative impact on survival. The purpose of this study is to analyze our bilobectomy experience. Methods: Age, gender, diagnosis, bilobectomy type, bilobectomy indication, operative technique, pathologic condition, major complications, stage, and survival were reviewed from 1984 through 2007. Major complications were compared by Fisher's exact testing. Kaplan-Meier survival curves were compared by log-rank and likelihood ratio analysis. Results: Bilobectomies were performed on 92 patients with non-small cell lung cancer. A total of 35 upper-middle and 57 middle-lower bilobectomies were performed. Indications for bilobectomy were bronchial involvement (n=49), extension across the fissure (n=36), or other reasons (n=7). The 5-year survival for all patients was 42%. Significant differences in survival were observed among the different stages (stage I, 65%; stage II, 42%; stage III, 13%; P < .0001). Squamous cell carcinomas had a higher 5-year survival than adenocarcinomas (54% vs 32%), a difference that approached significance by log-rank test (P<.079) and reached significance by likelihood ratios (P<.048). When bilobectomy was performed for extension across the fissure, survival approached significance for squamous cell carcinomas (71%) over adenocarcinomas (42%) by log-rank test (P<.089) and was significant by likelihood ratio (P<.048) when comparing survival between adenocarcinoma and squamous cell carcinoma. Multivariate analysis demonstrated that increasing age (P=.0102) and upper&middle bilobectomy (P=.0285) adversely affected 5-year survival, whereas early-stage disease (P=.0245) beneficially affected 5-year survival. Conclusion: Bilobectomy can be performed with acceptable morbidity and mortality. Survival relates to disease stage. Optimal survival benefit occurs when the indication for bilobectomy is squamous cell carcinoma extending across the fissure. (J Thorac Cardiovasc Surg 2010; 139: 606-11)