Long-term results of middle lobectomy patients operated for non-small cell lung cancer.

Abstract

Objectives: Lobectomy is the most frequently performed surgical treatment for lung cancer; isolated middle lobectomy (IML) is the least frequently performed lobectomy. Until recently, IML performed for Non-Small Cell Lung Cancer (NSCLC) located in the middle lobe of the lung was considered insufficient in oncologic surgery, and upper bilobectomy (Upper lobe + Middle lobe) or lower bilobectomy (Lower lobe + Middle lobe) was performed for isolated middle lobe tumors. Since postoperative morbidity and mortality rates are worse in bilobectomy compared to lobectomy, IMLs have become frequently performed. In this study, patients who underwent IML for NSCLC were compared with upper or lower lobectomies (ULL), and the oncologic results of patients who underwent IML were evaluated.

Materials and methods: In this study, 45 patients who underwent IML at our institution between 2012 and 2022 and 45 patients, who underwent right upper or lower lobectomy and were similar in terms of gender and age, were retrospectively analyzed. Oncological outcomes between these two groups were evaluated.

Results: The mean age of 45 patients, 34 (75.6%) male and 11 (24.5%) female, who underwent IML was found to be 62.5 ± 8.4 years. According to the type of surgery, 27 (60%) patients underwent thoracotomy and 18 (40%) patients underwent Video-Assisted Thoracoscopic Surgery (VATS). When tumor histopathologies were examined in all lobectomy patients, it was seen that squamous cell carcinoma was statistically significantly more dominant in IML patients than in the other two lobectomy groups (p = 0.014). In addition, it was seen that the tumor size was smaller in IML patients than in the other groups (p = 0.005). When the survival characteristics between these two groups were evaluated, the overall survival time (OS) of patients who underwent IML was 118.0 (59.0-124.0) months, while the overall survival time of patients who underwent ULL was 71.0 (66.0-74.0) months, and no statistically significant difference was found between the groups. No statistically significant difference was observed between the groups in terms of 30-day and 90-day mortality rates and 5-year survival rates.

Conclusion: There was no significant difference in survival between patients who underwent IML for NSCLC and those who underwent same-sided ULL. Based on these results, IML can be considered as an oncologically appropriate treatment option for masses confined to the middle lobe without the need for bilobectomy.

Graphical abstract:

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01886-4.