Is Bilateral Pulmonary Lobectomy Feasible in Patients with Bilateral Lung Cancers?

Abstract

Background While aggressive surgical resection is an acceptable strategy for bilateral lung cancers, there are still some controversies regarding the appropriate indications of bilateral pulmonary lobectomy.

Methods Between 1996 and 2012, 21 patients underwent bilateral pulmonary lobectomy for bilateral lung cancers. Postoperative complications after bilateral pulmonary lobectomy were defined based on the Common Terminology Criteria for Adverse Event Version 4.0 (National Cancer Institute, USA).

Results In this study, 21 patients underwent bilateral pulmonary lobectomy by staged surgery for bilateral lung cancers. Thirteen patients (62%) recovered without any complications after the second surgery. Among the eight (38%) patients with postoperative complications, four had relatively minor complications of grade 1 or 2. In contrast, postoperative complications were frequently observed in patients who underwent right lower lobectomy, were age ≥ 70 years, or had larger tumor size (p = 0.0041, 0.0195, 0.0324). The mean hospital stay after the second surgery was 8.0 days. In-hospital mortality was found in five patients including three of respiratory failure. The median follow-up period for all patients was 40 months. The 5-year survival rate after bilateral pulmonary lobectomy was 61.7%.

Conclusion Although appropriate patient selection and careful perioperative management are mandatory, bilateral pulmonary lobectomy could be an acceptable procedure for patients with bilateral lung cancers.

Keywords

bilateral pulmonary lobectomy - lung cancers - postoperative complication - survival

• References

• 1 Aberle DR, Adams AM, Berg CD , et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365 (5) 395-409
• 2 Shah AA, Barfield ME, Kelsey CR , et al. Outcomes after surgical management of synchronous bilateral primary lung cancers. Ann Thorac Surg 2012; 93 (4) 1055-1060 , discussion 1060
• 3 De Leyn P, Moons J, Vansteenkiste J , et al. Survival after resection of synchronous bilateral lung cancer. Eur J Cardiothorac Surg 2008; 34 (6) 1215-1222
• 4 Tsunezuka Y, Matsumoto I, Tamura M , et al. The results of therapy for bilateral multiple primary lung cancers: 30 years experience in a single centre. Eur J Surg Oncol 2004; 30 (7) 781-785
• 5 Aziz TM, Saad RA, Glasser J, Jilaihawi AN, Prakash D. The management of second primary lung cancers. A single centre experience in 15 years. Eur J Cardiothorac Surg 2002; 21 (3) 527-533
• 6 Adebonojo SA, Moritz DM, Danby CA. The results of modern surgical therapy for multiple primary lung cancers. Chest 1997; 112 (3) 693-701
• 7 Chang YL, Wu CT, Lee YC. Surgical treatment of synchronous multiple primary lung cancers: experience of 92 patients. J Thorac Cardiovasc Surg 2007; 134 (3) 630-637
• 8 Deschamps C, Pairolero PC, Trastek VF, Payne WS. Multiple primary lung cancers. Results of surgical treatment. J Thorac Cardiovasc Surg 1990; 99 (5) 769-777 , discussion 777–778
• 9 Finley DJ, Yoshizawa A, Travis W , et al. Predictors of outcomes after surgical treatment of synchronous primary lung cancers. J Thorac Oncol 2010; 5 (2) 197-205
• 10 Nakata M, Sawada S, Yamashita M , et al. Surgical treatments for multiple primary adenocarcinoma of the lung. Ann Thorac Surg 2004; 78 (4) 1194-1199
• 11 Rea F, Zuin A, Callegaro D, Bortolotti L, Guanella G, Sartori F. Surgical results for multiple primary lung cancers. Eur J Cardiothorac Surg 2001; 20 (3) 489-495
• 12 Rosengart TK, Martini N, Ghosn P, Burt M. Multiple primary lung carcinomas: prognosis and treatment. Ann Thorac Surg 1991; 52 (4) 773-778 , discussion 778–779
• 13 National Cancer Institute. NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Available at: http://evs.nci.nih.gov/ftp1/CTCAE/About.html . Accessed June 29, 2013
• 14 Goldstraw P, Crowley J, Chansky K , et al; International Association for the Study of Lung Cancer International Staging Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007; 2 (8) 706-714
• 15 Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg 1975; 70 (4) 606-612
• 16 Suzuki K, Kusumoto M, Watanabe S, Tsuchiya R, Asamura H. Radiologic classification of small adenocarcinoma of the lung: radiologic-pathologic correlation and its prognostic impact. Ann Thorac Surg 2006; 81 (2) 413-419
• 17 Hattori A, Suzuki K, Matsunaga T , et al. Is limited resection appropriate for radiologically “solid” tumors in small lung cancers?. Ann Thorac Surg 2012; 94 (1) 212-215
• 18 Hattori A, Suzuki K, Maeyashiki T , et al. The presence of air bronchogram is a novel predictor of negative nodal involvement in radiologically pure-solid lung cancer. Eur J Cardiothorac Surg 2014; 45 (4) 699-702
• 19 Linden PA, Yeap BY, Chang MY , et al. Morbidity of lung resection after prior lobectomy: results from the Veterans Affairs National Surgical Quality Improvement Program. Ann Thorac Surg 2007; 83 (2) 425-431 , discussion 432
• 20 Zuin A, Andriolo LG, Marulli G , et al. Is lobectomy really more effective than sublobar resection in the surgical treatment of second primary lung cancer?. Eur J Cardiothorac Surg 2013; 44 (2) e120-e125 , discussion e125
• 21 Okada M, Tsubota N, Yoshimura M, Miyamoto Y. Operative approach for multiple primary lung carcinomas. J Thorac Cardiovasc Surg 1998; 115 (4) 836-840
• 22 Markos J, Mullan BP, Hillman DR , et al. Preoperative assessment as a predictor of mortality and morbidity after lung resection. Am Rev Respir Dis 1989; 139 (4) 902-910
• 23 Trousse D, Barlesi F, Loundou A , et al. Synchronous multiple primary lung cancer: an increasing clinical occurrence requiring multidisciplinary management. J Thorac Cardiovasc Surg 2007; 133 (5) 1193-1200