Arame A, Rivera C, Pricopi C, Mordant P, Abdennadher M, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M
Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France.
Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, 76230 Bois-Guillaume, France.
Rev Pneumol Clin. 2014 Oct;70(5):260-8. doi: 10.1016/j.pneumo.2014.02.003. Epub 2014 Jun 2.
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.
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.
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.
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.
双叶切除术可因不同原因及针对不同肺部肿瘤进行。该手术的效果仍存在争议。我们回顾了我们的双叶切除术经验，以评估该切除术的特殊性。
前瞻性记录并回顾性分析了1980年至2009年间在两个法国中心接受肺部肿瘤手术患者的临床档案。然后比较了非小细胞肺癌（NSCLC）右侧切除术的特征、治疗、病理及生存情况。
在研究期间，共进行了3280例右侧切除术，其中235例（7%）为双叶切除术，192例（82%）为NSCLC。下中叶切除术（LML）占双叶切除术的60%，该组类癌肿瘤和鳞状细胞癌更为常见。上中叶切除术（UML）占双叶切除术的40%，该组术后并发症和死亡率较低。在N0期NSCLC中，双叶切除术后的术后死亡率和5年生存率（分别为4.7%和46.1%）介于肺叶切除术（2.7%和52.6%）和全肺切除术（9.6%和31.7%）之间（两组比较P<10⁻⁶）。根据双叶切除术的类型及是否进行任何诱导治疗，5年生存率无显著差异。
尽管术后并发症发生率增加，但双叶切除术的院内死亡率可接受，5年生存率令人鼓舞。UML与全肺切除术以及LML与肺叶切除术生存率相近，可能是由于组织学特征不同，伴有不同的裂隙延伸和叶间淋巴结受累情况。
