Bilobectomy for lung cancer: analysis of indications, postoperative results, and long-term outcomes

Ann Thorac Surg. 2012 Jan;93(1):251-7; discussion 257-8. doi: 10.1016/j.athoracsur.2011.08.086. Epub 2011 Nov 23.


Background: Bilobectomy for lung cancer is considered a high-risk procedure for the increased postoperative complication rate and the negative impact on survival. We analyzed the safety and the oncologic results of this procedure.

Methods: We retrospectively reviewed patients who underwent bilobectomy for lung cancer between October 1998 and August 2009. Age, gender, bilobectomy type and indication, complications, pathology, stage, and survival were analyzed.

Results: Bilobectomy was performed on 146 patients (101 men; mean age, 62 years). There were 77 upper-middle and 69 middle-lower bilobectomies. Indications were tumor extending across the fissure in 27 (18.5%) patients, endobronchial tumor in 39 (26.7%), extrinsic tumor or nodal invasion of bronchus intermedius in 66 (45.2%), and vascular invasion in 14 (9.6%). An extended resection was performed in 24 patients (16.4%). Induction therapy was performed in 43 patients (29.4%). Thirty-day mortality was 1.4% (n=2). Overall morbidity was 47.2%. Mean chest tube persistence was 7 days (range, 6 to 46 days). Overall 5-year survival was 58%. Significance differences in survival were observed among different stages (stage I, 70%; stage II, 55%; stage III, 40%; p=0.0003) and the N status (N0, 69%; N1, 56%; N2, 40%; p=0.0005). Extended procedure (p=0.0003) and superior bilobectomy (p=0.0008) adversely influenced survival. Multivariate analysis demonstrated that an extended resection (p=0.01), an advanced N disease (p=0.02), and an upper-mild lobectomy (p=0.02) adversely affected prognosis.

Conclusions: Bilobectomy is associated with a low mortality and an increased morbidity. Survival relates to disease stage and N factor. Optimal prognosis is obtained in patients with lower-middle lobectomy without extension of the resection.

Publication types

  • Comparative Study

MeSH terms

  • Biopsy
  • Bronchoscopy
  • Carcinoma, Non-Small-Cell Lung / diagnosis
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Carcinoma, Non-Small-Cell Lung / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Italy / epidemiology
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / mortality
  • Lung Neoplasms / surgery*
  • Male
  • Middle Aged
  • Morbidity / trends
  • Neoplasm Staging
  • Pneumonectomy / methods*
  • Positron-Emission Tomography
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Risk Factors
  • Survival Rate / trends
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome