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

authors

Contributors

Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE) ; Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48 ; INSB-INSB-Centre National de la Recherche Scientifique (CNRS),

CHU Strasbourg,

Service de chirurgie thoracique [AP-HP HEGP, Paris] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP) ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5),

Institut des Maladies Métaboliques et Cardiovasculaires (I2MC) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3) ; Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées,

CHU Toulouse [Toulouse],

Unité d'Aide Méthodologique ; Assistance Publique - Hôpitaux de Marseille (APHM)-CHU Marseille

+ 6

Publisher

HAL CCSD,

Oxford University Press (OUP)

Abstract

23rd European Conference on General Thoracic Surgery, Lisbon, PORTUGAL, ă MAY 31-JUN 03, 2015 International audience 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.