The place for bilobectomy in bronchogenic carcinoma

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Bronchogenic carcinoma treatment often involves pulmonary resection.
• Bilobectomy is a complex procedure for lung cancer when lobectomy or pneumonectomy is not optimal.
• Lung-sparing surgeries are increasingly important for patient outcomes.

Purpose of the Study:

• To evaluate the outcomes of bilobectomy for bronchogenic carcinoma.
• To compare bilobectomy morbidity and survival with pneumonectomy and lobectomy.
• To assess the functional impact of bilobectomy on long-term survivors.

Main Methods:

• Retrospective analysis of 148 patients undergoing bilobectomy for bronchogenic carcinoma (1978-1988).
• Categorization of bilobectomies into upper/middle lobe and lower/middle lobe resections.
• Comparison of mortality, complication rates (including bronchopleural fistula), and 5-year survival with pneumonectomy and lobectomy data.

Main Results:

• Overall mortality for bilobectomy was 6%, higher than pneumonectomy (4%) and lobectomy (3%).
• The complication rate was 55%, with a significantly higher incidence of bronchopleural fistula (11%) after lower/middle lobe bilobectomy compared to other procedures (P<0.01).
• Five-year survival was 43%, similar to comparable TNM stages after other resections, with residual right pulmonary function averaging 24% in survivors.

Conclusions:

• Bilobectomy is a viable option for lung cancer patients needing more than a lobectomy but requiring lung conservation.
• Despite increased morbidity, the procedure offers justifiable survival benefits and functional preservation.
• Careful patient selection is crucial for managing the risks associated with bilobectomy.