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Issard J, Brioude G, Mitilian D, Fabre D, Thomas de Montpreville V, Hanna A, Caramella C, Lepechoux C, Besse B, Mercier O, Fadel E. Outcomes of right sleeve lower lobectomy vs. lower bilobectomy for lung malignancies. Surg Oncol 2024; 56:102100. [PMID: 39024682 DOI: 10.1016/j.suronc.2024.102100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/09/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVES Lower bilobectomy (LBL) leaves a residual pleural space potentially associated with adverse postoperative outcomes. In selected patients, right sleeve lower lobectomy (RSLL) with anastomosis between the middle lobe bronchus and intermediate bronchus is feasible. The outcomes of RSLL and LBL have not been compared. The aim of this study was to compare post-operative and long-term outcomes of RSLL and LBL in patients with lung cancer. METHODS We retrospectively included patients managed by RSLL or LBL at our referral chest-surgery institution between 2001 and 2019. Post-operative complications and mortality were compared. Kaplan-Meier curves were plotted to compare overall and disease-free survival rates. RESULTS We identified 23 patients with RSLL and 96 with LBL. Postoperative mortality was 9 % after RSLL and 5 % after LBL (p = 0.41). Bronchial fistula developed in 3 (13 %) RSLL patients and 6 (6 %) LBL patients (p = 0.23). Pleural space complications were significantly less common after RSLL (4/23 [17 %] vs. 45/96 [47 %], p = 0.03). Long-term vital capacity was significantly higher in the RSLL group (91 % vs. 64 %, p < 0.01). Five-year survival did not differ significantly between groups (84 % vs. 72 %, p = 0.09). CONCLUSIONS RSLL was associated with similar postoperative mortality and long-term survival compared to LBL. However, pleural space complications were less common and lung function was better after RSLL than after LBL. When feasible, RSLL may deserve preference over LBL in patients with lung cancer managed at highly experienced centres.
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Affiliation(s)
- Justin Issard
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, CHU Hôpital Nord, Marseille, France
| | - Delphine Mitilian
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Dominique Fabre
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Vincent Thomas de Montpreville
- Department of Pathology, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Amir Hanna
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Caroline Caramella
- Department of Radiology, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Cécile Lepechoux
- Department of Radiation Therapy, Gustave Roussy, Université Paris-Saclay, International Center for Thoracic Cancers, Villejuif, France
| | - Benjamin Besse
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, International Center for Thoracic Cancers, Villejuif, France
| | - Olaf Mercier
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France.
| | - Elie Fadel
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
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Wang J, Guo J, Shi H, Chen X, He W, Li Z. A middle lobe sparing sleeve resection versus bilobectomy for right lower central non-small cell lung cancer: a retrospective propensity score matched cohort study. J Cardiothorac Surg 2024; 19:234. [PMID: 38627841 PMCID: PMC11020639 DOI: 10.1186/s13019-024-02744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES The right lower sleeve lobectomy is a rarely performed major lung resection.This study aims to evaluate the safety and effectiveness of this procedure by comparing to right lower bilobectomy in non-small cell lung cancer patients. METHODS We retrospectively reviewed a prospective database of non-small cell lung cancer patients who underwent right lower sleeve lobectomy (group S) or right lower bilobectomy (group B) from January 2014 to January 2020 in Shanghai Pulmonary Hospital. Propensity score matching method was applied to balance confounders between the two groups, resulting in 41 matched pairs.The analysis was performed to compare perioperative outcomes, long-term survival, and postoperative pulmonary volume between the two groups. RESULTS No significant differences in the characteristics were observed between the two matched groups.Major postoperative complications developed in 31.7% of the patients in group B and 12.1% of the patients in group S (P = 0.032).Intervention rate for surgical residual cavity in group B is significantly higher than those patients in group S(21.9%vs7.3%,p = 0.037).The postoperative right lateral and overall lung volume in group S were both significantly larger than that in group B (P = 0.026,P = 0.001,respectively). CONCLUSIONS Compared to bi-lobectomy, a middle lobe sparing sleeve resection obtains a less prevalence of major complications, smaller postoperative residual air space and similar long-term survival for selected central right lower NSCLC patients.
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Affiliation(s)
- Jiongjie Wang
- Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou, 221000, China
| | - Jichao Guo
- Department of Thoracic Surgery, Lanshan District People's Hospital of Linyi City, Linyi, 276000, China
| | - Haizhan Shi
- Department of Thoracic Surgery, The Third Clinical Medical College of Fujian Medical University, The First Hospital of Putian, Putian, 351100, China
| | - Xiangru Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, China
| | - Wenxin He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, China.
| | - Zhixin Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, China.
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Udelsman BV, Kim AW. The Small But Mighty Middle Lobe in a Larger-Lobe World. Ann Thorac Surg 2024; 117:171-172. [PMID: 37944657 DOI: 10.1016/j.athoracsur.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Brooks V Udelsman
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St, Ste 514, Los Angeles, CA 90033
| | - Anthony W Kim
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St, Ste 514, Los Angeles, CA 90033.
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Li AX, Canavan ME, Ermer T, Maduka RC, Zhan P, Pichert MD, Boffa DJ, Blasberg JD. Respect the Middle Lobe: Perioperative Risk of Bilobectomy Compared With Lobectomy and Pneumonectomy. Ann Thorac Surg 2024; 117:163-171. [PMID: 37774762 DOI: 10.1016/j.athoracsur.2023.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 08/06/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023]
Abstract
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 believed to represent a fraction of total lung function, the morbidity and mortality associated with bilobectomy is not well described. METHODS We retrospectively identified patients in The Society of Thoracic Surgeons Database who underwent lobectomy, bilobectomy, or pneumonectomy for lung cancer from 2009 to 2017. The primary outcome was 30-day perioperative mortality. We performed propensity matching by patient demographics, comorbidities, and perioperative variables for each surgical type against bilobectomy and ran Cox proportional hazard models. Secondary outcomes of 30-day morbidity and mortality of upper vs lower bilobectomy were also compared. RESULTS Within the study period 2911 bilobectomy, 65,506 lobectomy, and 3370 pneumonectomy patients met the inclusion criteria. Patients undergoing pneumonectomy and bilobectomy had fewer comorbidities than lobectomy patients. After propensity matching 30-day mortality of bilobectomy was comparable with left pneumonectomy (hazard ratio [HR], 1.35; 95% CI, 0.95-1.91; P = .09) and significantly worse than left (HR, 0.40; 95% CI, 0.29-0.56; P < .0001) or right (HR, 0.43; 95% CI, 0.31-0.59; P < .0001) lobectomy. Bilobectomy was associated with a survival advantage compared with right pneumonectomy (HR, 2.54; 95% CI, 1.72-3.74; P < .0001). Thirty-day morbidity was higher for bilobectomy compared with lobectomy, and upper bilobectomy had a significant unadjusted 30-day mortality advantage compared with lower bilobectomy (98.3% vs 97%, P = .04). CONCLUSIONS The morbidity and mortality of bilobectomy is significantly worse than lobectomy and is comparable with left pneumonectomy. The addition of middle lobectomy to a pulmonary resection is not without risk and should be carefully considered during preoperative risk stratification.
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Affiliation(s)
- Andrew X Li
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Maureen E Canavan
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Theresa Ermer
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Richard C Maduka
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Peter Zhan
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Matthew D Pichert
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Daniel J Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Justin D Blasberg
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
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Bodén E, Andreasson J, Hirdman G, Malmsjö M, Lindstedt S. Quantitative Proteomics Indicate Radical Removal of Non-Small Cell Lung Cancer and Predict Outcome. Biomedicines 2022; 10:2738. [PMID: 36359256 PMCID: PMC9687227 DOI: 10.3390/biomedicines10112738] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 12/03/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is associated with low survival rates, often due to late diagnosis and lack of personalized medicine. Diagnosing and monitoring NSCLC using blood samples has lately gained interest due to its less invasive nature. In the present study, plasma was collected at three timepoints and analyzed using proximity extension assay technology and quantitative real-time polymerase chain reaction in patients with primary NSCLC stages IA-IIIA undergoing surgery. Results were adjusted for patient demographics, tumor, node, metastasis (TNM) stage, and multiple testing. Major histocompatibility (MHC) class 1 polypeptide-related sequence A/B (MIC-A/B) and tumor necrosis factor ligand superfamily member 6 (FASLG) were significantly increased post-surgery, suggesting radical removal of cancerous cells. Levels of hepatocyte growth factor (HGF) initially increased postoperatively but were later lowered, potentially indicating radical removal of malignant cells. The levels of FASLG in patients who later died or had a relapse of NSCLC were lower at all three timepoints compared to surviving patients without relapse, indicating that FASLG may be used as a prognostic biomarker. The biomarkers were confirmed using microarray data. In conclusion, quantitative proteomics could be used for NSCLC identification but may also provide information on radical surgical removal of NSCLC and post-surgical prognosis.
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Affiliation(s)
- Embla Bodén
- Department of Clinical Sciences, Lund University, 22362 Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, 22363 Lund, Sweden
- Lund Stem Cell Center, Lund University, 22362 Lund, Sweden
| | - Jesper Andreasson
- Department of Clinical Sciences, Lund University, 22362 Lund, Sweden
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, 22242 Lund, Sweden
| | - Gabriel Hirdman
- Department of Clinical Sciences, Lund University, 22362 Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, 22363 Lund, Sweden
- Lund Stem Cell Center, Lund University, 22362 Lund, Sweden
| | - Malin Malmsjö
- Department of Clinical Sciences, Lund University, 22362 Lund, Sweden
| | - Sandra Lindstedt
- Department of Clinical Sciences, Lund University, 22362 Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, 22363 Lund, Sweden
- Lund Stem Cell Center, Lund University, 22362 Lund, Sweden
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, 22242 Lund, Sweden
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Watanabe T, Tanahashi M, Suzuki E, Yoshii N, Tsuchida H, Yobita S, Iguchi K, Uchiyama S, Nakamura M. Surgical treatment for synchronous multiple primary lung cancer: Is it possible to achieve both curability and preservation of the pulmonary function? Thorac Cancer 2021; 12:2996-3004. [PMID: 34590424 PMCID: PMC8590900 DOI: 10.1111/1759-7714.14164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND With the advent of high-resolution chest imaging, the number of patients diagnosed with multiple primary lung cancers is increasing. For the treatment of multiple lung cancers, a surgical procedure that preserves pulmonary function while ensuring curability is required. METHODS The study population included 85 patients with synchronous multiple primary lung cancer who received surgical resection between January 2010 and September 2020. Patients with synchronous lung cancer within the same lobe were excluded, and only patients with ≥2 involved lobes were included. The postoperative pulmonary function was examined at 3-6 months after the surgery. RESULTS Sixty-seven patients had cancers within the ipsilateral lobe, and 18 patients had cancers in bilateral lobes. Seventy-six patients (89.4%) underwent combination surgery with limited resection (e.g., segmentectomy and wedge resection). The preoperative pulmonary functions (mean VC/%VC, mean FEV1 /%FEV1 , and mean %DLCO) were 3.06 L/100.2%, 2.23 L/96.1%, and 117.2%, respectively, and the postoperative pulmonary functions were 2.45 L/81.4%, 1.87 L/81.2%, and 102.6%. In each parameter, the predicted reductions of pulmonary function were almost the same as the predicted values. The 5-year survival rate was 85.0%. The 5-year survival rate according to the most advanced pathological stage was 94.9% for stage I disease, and 62.6% for stage ≥II, which was a significant difference (p < 0.001). CONCLUSIONS Surgical treatment including limited resection, especially segmentectomy and wedge resection, for synchronous multiple primary lung cancer can preserve pulmonary function while ensuring curability.
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Affiliation(s)
- Takuya Watanabe
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Masayuki Tanahashi
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Eriko Suzuki
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Naoko Yoshii
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Hiroyuki Tsuchida
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Shogo Yobita
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Kensuke Iguchi
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Suiha Uchiyama
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Minori Nakamura
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Shizuoka, Japan
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Xu S, Bie ZX, Li YM, Li B, Guo RQ, Li XG. Computed tomography-guided microwave ablation for the treatment of non-small cell lung cancer patients with and without adjacent lobe invasion: A comparative study. Thorac Cancer 2021; 12:2780-2788. [PMID: 34427998 PMCID: PMC8520792 DOI: 10.1111/1759-7714.14125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of the study was to explore the outcomes of computed tomography-guided microwave ablation (MWA) in non-small cell lung cancer (NSCLC) patients with adjacent lobe invasion (ALI), and to compare the outcomes of ALI-NSCLC and non-ALI NSCLC patients after MWA. METHODS A total of 319 NSCLC patients and 366 tumors treated with MWA were included in the study, comprising 34 ALI-NSCLC patients and 285 non-ALI NSCLC patients. Complications, local recurrence rates, progression-free survival (PFS), and overall survival (OS) were compared. Logistic regression analyses were used to investigate the correlation between ALI and the occurrence of pneumothorax after MWA. RESULTS The mean tumor diameter of ablated tumors was 3.6 ± 2.2 cm. There were 95 (29.8%) NSCLC patients in which pneumothorax occurred after MWA, and all patients recovered. Of these, the ALI group had a significantly higher incidence rate of pneumothorax than the non-ALI group (52.9% vs. 27.0%, p = 0.002). The median PFS and OS for the ALI group were 12.0 ± 10.2 and 15.5 ± 9.5 months, respectively, and that of the non-ALI group were 13.0 ± 10.6 and 17.0 ± 11.1 months, respectively, and no significant difference was found in PFS (p = 0.329) nor OS (p = 0.394) between the two groups. Local recurrence rates for ALI and non-ALI groups were 29.4% and 20.7%, respectively, and no significant difference was found (p = 0.244). Logistic regression analyses revealed that ALI can increase the risk of pneumothorax (hazard ratio [HR], 2.867; p = 0.012). CONCLUSIONS MWA is an effective and safe approach for ALI-NSCLC treatment. Although ALI can increase the risk of pneumothorax, ALI-NSCLC patients reveal a comparable outcome to non-ALI NSCLC patients after MWA.
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Affiliation(s)
- Sheng Xu
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhi-Xin Bie
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuan-Ming Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Run-Qi Guo
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Guang Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Surgical Management of Non-Small Cell Lung Cancer Invading the Fissure: Less Is More? Ann Thorac Surg 2020; 111:231-236. [PMID: 32653363 DOI: 10.1016/j.athoracsur.2020.05.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/14/2020] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND When a resectable lung cancer that invades across the fissure into an adjacent lobe is encountered, options include a bilobectomy on the right or a pneumonectomy on the left vs a parenchymal-sparing resection combined with a lobectomy. Although parenchymal-sparing combinations are technically possible, the available literature reporting on the related oncologic outcomes is limited. We sought to examine the influence of resection extent on overall survival and recurrence patterns in this scenario. METHODS A single-center retrospective medical record review from 2006 to 2018 was performed on all preoperative computed tomography and operative reports of resections greater than a lobectomy. Patients were grouped into maximal resection: bilobectomy or pneumonectomy, and parenchymal-sparing resection: lobectomy with en bloc segment or nonanatomic wedge. Overall survival and cumulative incidence of recurrence were calculated. RESULTS The size of our cohort was 54 patients; 19 maximal and 35 parenchymal-sparing resections. All resections were reported as complete (R0). The parenchymal-sparing group had lower odds of immediate surgical morbidity (odds ratio, 0.13; 95% confidence interval, 0.02-0.74; P = .02). Parenchymal-sparing resection was not associated with an increased cumulative incidence of recurrence (P = .98). Postresection estimated overall survival between the 2 cohorts was not significantly different (P = .30). CONCLUSIONS When technically feasible, a parenchymal-sparing resection is a good option for the resection of tumors that invade across the fissure. R0 parenchymal-sparing resections do not appear to compromise the oncologic outcomes of overall survival or cumulative incidence of recurrence and also seem to carry less morbidity.
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Thomas PA, Falcoz PE, Bernard A, Le Pimpec-Barthes F, Jougon J, Brouchet L, Massard G, Dahan M, Loundou A. Bilobectomy for lung cancer: contemporary national early morbidity and mortality outcomes. Eur J Cardiothorac Surg 2015; 49:e38-43; discussion e43. [DOI: 10.1093/ejcts/ezv407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/19/2015] [Indexed: 11/14/2022] Open
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10
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Force S. Invited Commentary. Ann Thorac Surg 2015; 100:250. [PMID: 26140765 DOI: 10.1016/j.athoracsur.2015.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 03/18/2015] [Accepted: 03/23/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Seth Force
- Cardiothoracic Surgery, Emory University, The Emory Clinic, 1365 Clifton Rd, NE, Bldg A, Ste 2100, Atlanta, GA 30322.
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11
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Xie D, Deschamps C, Shen RK, Deng B, Wampfler JA, Cassivi SD, Nichols FC, Allen MS, Wigle DA, Yang P. Bilobectomy Versus Lobectomy for Non-Small Cell Lung Cancer: A Comparative Study of Outcomes, Long-Term Survival, and Quality of Life. Ann Thorac Surg 2015; 100:242-50. [DOI: 10.1016/j.athoracsur.2015.03.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
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12
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Arame A, Rivera C, Pricopi C, Mordant P, Abdennadher M, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M. [Place of bilobectomy in pulmonary oncology and prognostic factors in NSCLC]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:260-268. [PMID: 24932506 DOI: 10.1016/j.pneumo.2014.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Bilobectomy may be performed for different reasons and lung tumors. There are still controversies regarding the results of this procedure. We reviewed our experience of bilobectomy to evaluate the particularities of this resection. METHODS The clinical files of patients operated on for lung tumors in two French centers between 1980 and 2009 were prospectively recorded and retrospectively analyzed. The characteristics, management, pathology, and survival after right-sided resections for non-small cell lung cancer (NSCLC) were then compared. RESULTS During the study period, 3280 right-sided resections were performed, including 235 bilobectomy (7%), for NSCLC in 192 cases (82%). Lower-middle lobectomy (LML) represented 60% of bilobectomy, with carcinoid tumors and squamous cell carcinoma being more frequent in this group. Upper-middle lobectomy (UML) represented 40% of bilobectomy, with less postoperative complications and mortality in this group. In N0-NSCLC, the rate of postoperative mortality and 5-year survival rates after bilobectomy (4.7% and 46.1%, respectively) were intermediate between lobectomy (2.7% and 52.6%) and pneumonectomy (9.6% and 31.7%, P<10(-6) for both comparisons). There was no significant difference in 5-year survival rates according to the type of bilobectomy and the performance of any induction therapy. CONCLUSION Bilobectomy is associated with acceptable in-hospital mortality and encouraging 5-year survival rates despite an increased incidence of postoperative complications. Approximation in survival of UML and pneumonectomy and of LML and lobectomy may be due to differences in histologic features with different fissure extension and interlobar node involvement.
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Affiliation(s)
- A Arame
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - C Rivera
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - P Mordant
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - M Abdennadher
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - C Foucault
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - A Dujon
- Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, 76230 Bois-Guillaume, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France.
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陈 颖, 雷 玉, 黄 云, 叶 联, 赵 光, 李 光, 杨 凯, 黄 秋. [Postoperative complications of bilobectomy compared with lobectomy in the right lung of non-small cell lung cancer patients]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:596-600. [PMID: 25130965 PMCID: PMC6000366 DOI: 10.3779/j.issn.1009-3419.2014.08.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 03/25/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND The mismatch between pleural space and remnant lung after bilobectomy has been considered as the main reason for the high incidence of postoperative complications in non-small cell lung cancer (NSCLC) patients. The aim of this study is to analyze the differences in postoperative complications between bilobectomy and lobectomy in the right lung of NSCLC patients. METHODS This study included 528 NSCLC patients who underwent right pulmonary lobectomy. A total of 352 cases that underwent upper or lower right lobectomy (108 upper and 244 lower) were the control group, and 176 cases that underwent bilobectomy (57 upper and middle and 119 lower and middle) were the observation group. A retrospective case-control study was performed on a series of matched NSCLC patients. Cases and controls were matched by age, ppoFEV1%, LEVF%, operation method, cardiac comorbidity, type of postoperative management, and pathological type at a ratio of 1:2. The prevalence of 30-day death, occurrence of cardiac-respiratory complications (hospital-acquired pneumonia, low oxygen concentration, pulmonary embolism, cerebral apoplexy, arrhythmia, myocardial ischemia or infarction, and cardiac insufficiency) and occurrence of space-related complications (atelectasis, air leak more than 5 days, and pneumothorax) were compared between the bilobectomy and lobectomy groups. RESULTS The prevalence of 30-day death was 3.4% (6/176) in the bilobectomy group and 2.3% (8/352) in the lobectomy group. No statistical significance was observed between the two groups. The cardiac-respiratory complication rate in bilobectomy group (23.8%; 42/176) was higher than that in lobectomy group (10.7%; 38/352). The cardiac-respiratory complication rate of the lower and middle pulmonary lobectomy patients in the bilobectomy group (26.5%; 31/119) was significantly higher than that in the lower pulmonary lobectomy patients (4.9%; 12/244). The space-related complications in bilobectomy group and lobectomy group were 20.4% (36/176) and 17.3% (61/352), respectively. No statistically significant difference between the two groups was observed. CONCLUSIONS The postoperative cardiac-respiratory complications of NSCLC patients with right bilobectomy are higher than those of the right lobectomy patients, but the prevalence of 30-day death and space-related complication was not statistically different between the two groups.
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Affiliation(s)
- 颖 陈
- />650118 昆明,昆明医科大学第三附属医院,云南省肿瘤医院胸外科一病区Deparment of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming 650118, China
| | - 玉洁 雷
- />650118 昆明,昆明医科大学第三附属医院,云南省肿瘤医院胸外科一病区Deparment of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming 650118, China
| | - 云超 黄
- />650118 昆明,昆明医科大学第三附属医院,云南省肿瘤医院胸外科一病区Deparment of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming 650118, China
| | - 联华 叶
- />650118 昆明,昆明医科大学第三附属医院,云南省肿瘤医院胸外科一病区Deparment of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming 650118, China
| | - 光强 赵
- />650118 昆明,昆明医科大学第三附属医院,云南省肿瘤医院胸外科一病区Deparment of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming 650118, China
| | - 光剑 李
- />650118 昆明,昆明医科大学第三附属医院,云南省肿瘤医院胸外科一病区Deparment of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming 650118, China
| | - 凯云 杨
- />650118 昆明,昆明医科大学第三附属医院,云南省肿瘤医院胸外科一病区Deparment of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming 650118, China
| | - 秋博 黄
- />650118 昆明,昆明医科大学第三附属医院,云南省肿瘤医院胸外科一病区Deparment of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming 650118, China
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Gómez MT, Jiménez MF, Aranda JL, Rodríguez M, Novoa NM, Varela G. The risk of bilobectomy compared with lobectomy: a retrospective analysis of a series of matched cases and controls. Eur J Cardiothorac Surg 2013; 46:72-5. [PMID: 24242849 DOI: 10.1093/ejcts/ezt521] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Bilobectomy is considered to be a risky procedure due to space mismatch between the pleural space and the remnant lung. The objective of this study was to evaluate if postoperative complications related or not to size mismatch are more frequent after bilobectomy compared with right lobectomy cases. METHODS Retrospective case-control study on a series of matched non-small-cell lung cancer patients. Cases were patients who underwent right bilobectomy (upper and middle or lower and middle) and controls, patients who underwent right upper or lower lobectomy. Cases and controls were matched by propensity scoring according to site, age, ppoFEV1, type of postoperative management (intensive physiotherapy or not), cardiac comorbidity and pT status. We selected two primary outcomes for comparison: occurrence of any cardiorespiratory complication and occurrence of any complication related to space discrepancies. For the latter, all complicated case records were reviewed and two blinded observers agreed on the probability of each complication to be related to space discrepancies. Agreement was measured by the κ statistic. The overall odds ratio (OR) and 95% confidence interval (CI) for each outcome were calculated on 2 × 2 tables for the whole population and for cases with upper or lower resections. RESULTS The study included 689 patients: 572 right lobectomy (419 upper and 153 lower) and 117 bilobectomy cases (30 upper and middle and 87 lower and middle). The overall mortality rate of the series was 2.03% (14/689), and cardiorespiratory complications were recorded in 14.4% (99/689) and space-related complications in 19.59% (135/689) cases. Both observers agreed on space-related complications in 86% of the 135 cases (κ: 0.72). After matching, 234 cases entered the study (117 with right lobectomy, including 83 lower and 34 upper, and 117 with bilobectomy, including 87 lower and 30 upper). The prevalence of cardiorespiratory complications was higher after lower and middle lobectomy compared with lower lobectomy (P = 0.0002; OR: 7.96, 95% CI: 2.19-43.16). No differences were found in death rates or in space-related complications between groups of lobectomy and bilobectomy cases. CONCLUSIONS This study failed to demonstrate a higher space-related complication rate in bilobectomy cases but cardiorespiratory complications were statistically higher after lower and middle lobectomy compared with lower lobectomy in matched cases.
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Affiliation(s)
- María Teresa Gómez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | | | - José Luis Aranda
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - María Rodríguez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Nuria María Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Gonzalo Varela
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
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Icard P, Heyndrickx M, Galateau-Sallé F, Rosat P, Lerochais JP, Gervais R, Zalcman G, Hanouz JL. Does Bilobectomy Offer Satisfactory Long-Term Survival Outcome for Non-Small Cell Lung Cancer? Ann Thorac Surg 2013; 95:1726-33. [DOI: 10.1016/j.athoracsur.2013.01.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/15/2013] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
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Icard P, Heyndrickx M, Guetti L, Galateau-Salle F, Rosat P, Le Rochais JP, Hanouz JL. Morbidity, mortality and survival after 110 consecutive bilobectomies over 12 years. Interact Cardiovasc Thorac Surg 2012; 16:179-85. [PMID: 23117235 DOI: 10.1093/icvts/ivs419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To analyse statistical aspects of mortality, morbidity and survival after bilobectomy (BT), an operation rarely studied in the literature. METHODS One hundred and ten cases were studied, comprising 58 upper-middle bilobectomies and 52 lower-middle bilobectomies performed between 1999 and 2010. Indications were of 9 benign diseases, 12 carcinoid tumours, 5 metastases and 84 non-small cell lung cancers (2 stage 0; 34 stage I; 22 stage II; 25 stage III and 1 stage IV). RESULTS Mortality was nil. Twenty-six percent of patients experienced significant morbidity, influenced in multivariate analysis by the presence of three or more comorbidities (P = 0.03) and by a forced expiratory volume in 1 s of <60% (P = 0.01). Lower-middle BT was associated with more postoperative complications than upper-middle BT (P = 0.012). The 5-year survival rate of patients with non-small cell lung carcinoma was 82% in stage I, 59% in stage II and 20% in stage IIIA. Survival was significantly influenced by stage (P = 0.0018) and tobacco weaning (P = 0.0012). CONCLUSIONS BT can be achieved with low mortality, and survival results that are comparable with those unregistered after standard lobectomy. However, almost one quarter of patients experienced significant postoperative complications. Surgical techniques aiming to reduce residual pleural space should be especially considered after lower-middle BT, due to the highest morbidity being associated with this procedure.
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Affiliation(s)
- Philippe Icard
- Department of Thoracic Surgery, University of Caen Basse-NormandSie and University Hospital of Caen, Caen, France
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