Respect the Middle Lobe: Perioperative Risk of Bilobectomy Compared With Lobectomy and Pneumonectomy

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Bilobectomy may be necessary for right-sided lung cancer due to tumor extension, bronchial involvement, or pulmonary artery infiltration.
• The middle lobe's contribution to lung function is considered small, but the risks of bilobectomy are not well-documented.

Purpose of the Study:

• To compare the 30-day perioperative mortality and morbidity of bilobectomy with lobectomy and pneumonectomy for lung cancer.
• To evaluate the outcomes of upper versus lower bilobectomy.

Main Methods:

• Retrospective analysis of The Society of Thoracic Surgeons Database (2009-2017).
• Inclusion of patients undergoing lobectomy, bilobectomy, or pneumonectomy for lung cancer.
• Propensity matching and Cox proportional hazard models were used to compare outcomes.

Main Results:

• Bilobectomy had comparable 30-day mortality to left pneumonectomy but significantly worse outcomes than left or right lobectomy.
• Compared to right pneumonectomy, bilobectomy showed a survival advantage.
• Thirty-day morbidity was higher for bilobectomy than lobectomy, with upper bilobectomy showing a mortality advantage over lower bilobectomy.

Conclusions:

• Bilobectomy is associated with significantly higher morbidity and mortality compared to lobectomy, and similar mortality to left pneumonectomy.
• The decision to include middle lobectomy in pulmonary resection requires careful preoperative risk stratification due to associated risks.