Bilobectomy Versus Lobectomy for Non-Small Cell Lung Cancer: A Comparative Study of Outcomes, Long-Term Survival, and Quality of Life

摘要

Preoperative EvaluationQuality of Life AssessmentStatistical AnalysisResultsLong-Term OutcomesPostoperative QOLComparison Between Upper and Middle Lobe Group and Middle and Lower Lobe GroupCommentSupplementary DataReferencesWe aimed to compare long-term survival and quality of life (QOL) outcomes after bilobectomy and lobectomy for non-small cell lung cancer patients.MethodsA cohort of 951 consecutive patients was identified from a single treatment institution, of whom 128 underwent bilobectomy and 823, lobectomy. Propensity score matching (1:3) was applied to balance known confounders between the two surgical groups and resulted in 512 patients (matched cohort). Unmatched and matched analyses were performed to compare clinical outcomes between the two groups, including operative mortality rate, morbidity rate, long-term survival, overall QOL, and specific symptoms.ResultsOperative mortality was higher in the bilobectomy group than in the lobectomy group (2.3% versus 0.5%, p?= 0.022). Morbidity rates did not differ significantly between the two groups in either unmatched or matched cohort. In the unmatched analysis, the overall survival (OS [p?= 0.003]) and disease-free survival (DFS [p?= 0.003]) were significantly lower in the bilobectomy group; whereas in the matched analysis, no significant difference was found in either OS (p?= 0.473) or DFS (p?= 0.387). Using multivariate analysis, the operation type was not found to be a significant factor for either OS (hazard ratio 1.18; 95% confidence interval: 0.91 to 1.52; p?= 0.22) or DFS (hazard ratio 1.22; 95% confidence interval: 0.95 to 1.58; p?= 0.13). Patients who underwent bilobectomy appeared to have similar measures of QOL as lobectomy patients, except for coughing and dyspnea.ConclusionsOur findings indicate that patients with non-small cell lung cancer treated with bilobectomy had similar morbidity, OS, DFS, and overall QOL as patients treated with lobectomy, but had higher mortality by matched analysis.The Supplementary FigureSupplementary Figure?and TablesTables can be viewed in the online version of this article [http://dx.doi.org/10.1016/j.athoracsur.2015.03.018] on http://www.annalsthoracicsurgery.org.Bilobectomy is generally considered a standard radical procedure for patients with lung cancer invading both superior and middle or lower and middle lobes. The first bilobectomy was performed by Churchill in 1932 [