ARE BILOBECTOMIES ACCEPTABLE PROCEDURES

Background. Controversy about operative morbidity and oncologic value of bilobectomy has led to a review of our experience over the past 12 years. Methods. The charts of 112 patients (100 men and 12 women with a mean age of 63 years) were reviewed for operative mortality and morb idity and long-term survival. Survival of patients with stage I or sta ge II disease was compared with that of stage-matched and age-matched groups having right pneumonectomy. Results. Four patients (3.5%) died postoperatively. Nonfatal complications occurred in 55 patients (49%); the most frequent problem was pleural space disease (34%). Survival s tudies focused on the 96 patients with nonsmall cell bronchogenic canc er (44 in stage I, 32 in stage II, and 20 in stage IIIA). The overall 5-year survival rate was 40%; the 5-year survival rate was similar for stage I and stage II (41% for stage I, 50% for stage II, and 17% for stage IIIA). The incidence of local recurrence was significantly incre ased after bilobectomy for stage I cancer (chi(2) = 5.066; p < 0.05) c ompared with pneumonectomy but did not affect 5-year survival. Local r ecurrence and survival were similar after bilobectomy and pneumonectom y in stage II. Conclusions. These data demonstrate an increased morbid ity after bilobectomy. Survival studies demonstrate an increased risk of local recurrence in patients with stage I disease, which might be p artly explained by understaging.