Peri-operative survival in bilobectomy is comparable with that of left pneumonectomy

In a retrospective analysis, the morbidity and mortality of bilobectomy were significantly worse than those of lobectomy and comparable with the outcomes of left pneumonectomy, but superior to those of right pneumonectomy.

Bilobectomy is the resection of two lobes in the right lung, including the middle lobe. It is a rare procedure and is performed in some cases of right-sided lung cancer, tumour extension, bronchial involvement, or pulmonary artery infiltration, or to avoid the morbidity and mortality of a right pneumonectomy. However, the morbidity and mortality associated with bilobectomy in comparison with other pulmonary resections are not well described. Therefore, investigators retrospectively compared outcomes from bilobectomy with outcomes from both lobectomy and pneumectomy [1].

Patients who underwent elective lobectomy, bilobectomy, or pneumonectomy for lung cancer between 2009 and 2017, excluding reoperations, were identified in the Society for Thoracic Surgeons General Thoracic Surgery Database. The primary outcome of the analysis was 30-day peri-operative mortality. Secondary outcomes included 30-day morbidity and mortality of upper versus lower bilobectomy. Dr Andrew Li (Yale School of Medicine, CT, USA) presented the results [1].

A total of 2,911 bilobectomy, 65,506 lobectomy, and 3,024 pneumonectomy patients were included in the analysis. The 30-day peri-operative mortality of bilobectomy was not significantly different from left pneumonectomy (HR 1.31; P=0.10). The 30-day peri-operative mortality of bilobectomy was significantly worse than that of left or right lobectomy (HR 0.44 and HR 0.47, respectively; both P<0.01) but better than that of right pneumonectomy (HR 2.76; P<0.01). Bilobectomy had the same 30-day post-operative morbidity as pneumonectomy (49.8% vs 48.0%), while 30-day post-operative morbidity in lobectomy patients was 38%. Bilobectomy had the highest rate of pneumonia of all procedures (7.5%).

Of note, upper bilobectomy patients (5 segments involved) fared better than lower bilobectomy patients (7 segments involved). In fact, survival in lower bilobectomy patients closely mirrored the survival in left pneumonectomy patients.

Based on these results, Dr Li concluded that peri-operative mortality of bilobectomy is worse than that of lobectomy and more comparable with that of left pneumonectomy. However, as survival of bilobectomy is superior to that of right pneumonectomy, it spares patients the increased risks of right pneumonectomy.

1. Li A, et al. Respect the middle lobe: Perioperative survival of bilobectomy compared to lobectomy and pneumonectomy. Abstract 109MO. ELCC 2022 Virtual Meeting, 30 March–02 April.

 

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Posted on 25 May, 2022