Bilobectomy for lung cancer: contemporary national early morbidity and ă mortality outcomes

Abstract : To determine contemporary early outcomes associated with bilobectomy for ă lung cancer and to identify their predictors using a nationally ă representative general thoracic surgery database. ă A total of 1831 patients, who underwent elective bilobectomy for primary ă lung cancer between 1 January 2004 and 31 December 2013, were selected. ă Logistic regression analysis was performed on variables for major ă adverse events. ă There were 670 upper and 1161 lower bilobectomies. Video-assisted ă thoracic surgery was seldom performed (2%). Induction therapy and ă extended resection were performed in 293 (16%) and 279 patients ă (15.2%), respectively. Operative mortality was 4.8% (upper: ă 4.5%/lower: 5%; P = 0.62), and significantly higher following extended ă procedures when compared with standard bilobectomy (4.3 vs 7.5%; P = ă 0.013). Pulmonary complication rate was 21.1%. Bronchial fistula ă occurred in 46 patients (2.5%) and pleural space complications in 296 ă (16.2%). Their respective incidence rates were significantly higher ă following lower than upper bilobectomy (3.5 vs 0.7%; P < 0.001 and 17.8 ă vs 13.3%; P = 0.007). At multivariate analysis, extended procedures ă [odds ratio (OR), 2.3; 95% confidence interval (CI), 1.03-5.31; P = ă 0.04], ASA scores of 3 or greater (OR, 2.02; 95% CI, 1.33-3.07; P < ă 0.001) and World Health Organization performance status 2 or greater ă (OR, 1.47; 95% CI, 1.01-2.13; P = 0.04) were risk predictors of ă mortality. Female gender (OR, 0.39; 95% CI, 0.19-0.80; P = 0.01), ă highest body mass index (BMI) values (OR, 0.91; 95% CI, 0.86-0.96; P = ă 0.001) and recent years of surgery (OR, 0.91; 95% CI, 0.84-0.99; P = ă 0.02) were protective. Predictors of bronchial fistula were male gender, ă lowest BMI values, lower bilobectomy and longest operative times. Male ă gender, lowest BMI values and longest operative times were also ă predictors of pulmonary complications, together with highest ASA scores ă and lowest forced expiratory volume in 1 s values. ă Risks related to lower bilobectomy lie halfway between those reported ă for lobectomy and pneumonectomy. Additional surgical measures to prevent ă pleural space complications and bronchial fistula should be encouraged ă with this operation. In contrast, upper bilobectomy shares more or less ă the same hazards as lobectomy.
Keywords : Quality
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Submitted on : Friday, March 3, 2017 - 4:02:15 PM
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Pascal A. Thomas, Pierre-Emmanuel Falcoz, Alain Bernard, Françoise Le Pimpec-Barthes, Jacques Jougon, et al.. Bilobectomy for lung cancer: contemporary national early morbidity and ă mortality outcomes. European Journal of Cardio-Thoracic Surgery, Oxford University Press (OUP), 2016, 49 (2), pp.e38-e43. ⟨hal-01482518⟩

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