Abstract 109MO
Background
In some cases of right-sided lung cancer, tumor extension, bronchial involvement, or pulmonary artery infiltration may necessitate bilobectomy. Although the middle lobe is thought to represent only a small fraction of the total right lung function, the morbidity and mortality associated with bilobectomy in comparison to other pulmonary resections is not well described.
Methods
We retrospectively identified patients in the Society for Thoracic Surgeons General Thoracic Surgery Database who underwent elective lobectomy, bilobectomy, or pneumonectomy for lung cancer from 2009 to 2017, excluding reoperations. The primary outcome was 30-day perioperative mortality. Cox proportional hazards were calculated after adjusting for patient demographics, comorbidities, and perioperative variables. Secondary outcomes included 30-day morbidity, mortality of upper versus lower bilobectomy, and rate of nodal upstaging or downstaging.
Results
Within the study period, 2,911 bilobectomy, 65,506 lobectomy, and 3,024 pneumonectomy patients met inclusion criteria. Patients undergoing pneumonectomy and bilobectomy had fewer comorbidities than lobectomy patients. Both unadjusted and adjusted 30-day mortality of bilobectomy were comparable to a left pneumonectomy, which was worse than left or right lobectomy but better than right pneumonectomy (Table). Bilobectomy had consistently worse 30-day morbidity than lobectomy. Upper bilobectomy had a small but significant unadjusted 30-day survival advantage compared to lower bilobectomy (98.3% vs 97%, log-rank p=0.04). Nodal upstaging of bilobectomy (22.8%) fell between that of lobectomy and pneumonectomy. Table: 109MO
Adjusted 30-day Cox proportional hazards and absolute mortality
| Cox proportional hazard | HR | 95% CI | p | Absolute mortality |
| Bilobectomy | ref | - | - | 2.6% |
| Left lobectomy | 0.44 | 0.34-0.56 | <0.0001 | 1.0% |
| Right lobectomy | 0.47 | 0.36-0.60 | <0.0001 | 1.1% |
| Left pneumonectomy | 1.32 | 0.95-1.85 | 0.10 | 3.5% |
| Right pneumonectomy | 2.76 | 2.01-3.81 | <0.0001 | 7.0% |
Conclusions
The morbidity and mortality of bilobectomy is significantly worse than lobectomy and is comparable to the outcomes of left pneumonectomy. The addition of middle lobectomy to a pulmonary resection is not without risk and should be carefully considered during pre-operative risk stratification.
Editorial acknowledgement
The data for this research were provided by The Society of Thoracic Surgeons’ (STS) National Database Participant User File (PUF) Research Program. Data analysis was performed at the investigators’ institution(s). This abstract was reviewed and approved by the STS PUF Task Force.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
D.J. Boffa: Financial Interests, Personal, Principal Investigator: Epic Sciences. All other authors have declared no conflicts of interest.