What is the 5‑year survival rate for a 67‑year‑old former smoker who underwent a bilobectomy for stage III non‑small‑cell lung cancer?

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Last updated: February 16, 2026 • View editorial policy

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5-Year Survival for Stage III NSCLC After Bilobectomy

For a 67-year-old former smoker who underwent bilobectomy for stage III NSCLC, the 5-year survival rate is approximately 30-40%, though this is significantly lower than lobectomy and approaches the poor outcomes seen with pneumonectomy. 1, 2, 3

Stage-Specific Survival Data

The prognosis for stage III NSCLC is inherently poor compared to earlier stages:

  • Stage IIIA (N2) disease has a 5-year survival of approximately 16% when treated with standard concurrent chemoradiotherapy 3
  • Overall stage III survival ranges from 13-36% depending on substage (IIIA: 36%, IIIB: 26%, IIIC: 13%) 4
  • Resected stage IIIA disease achieves 5-year survival of approximately 23-40% with complete surgical resection, though this varies significantly by nodal status 1, 2

The Bilobectomy Problem

Bilobectomy carries substantially worse outcomes than standard lobectomy for stage III disease:

  • 30-day mortality after bilobectomy following neoadjuvant chemoradiotherapy is 8.7%, compared to only 1.5% for lobectomy 5
  • 90-day mortality reaches 13% for bilobectomy versus 5.9% for lobectomy in stage IIIA-N2 patients 5
  • 5-year survival after bilobectomy for N0 disease is only 46.1%, which is intermediate between lobectomy (52.6%) and pneumonectomy (31.7%) 6
  • Bilobectomy outcomes are similar to pneumonectomy in terms of overall survival, disease-free survival, and postoperative mortality when performed after neoadjuvant therapy 5

Critical Prognostic Factors in Your Case

Several factors influence your specific prognosis:

  • Nodal status is the most critical determinant - N2 disease (multistation mediastinal nodes) has 40% 5-year survival versus 69% for N0 disease after bilobectomy 7
  • Type of bilobectomy matters - upper-middle bilobectomy has worse survival (adversely affects prognosis, p=0.02) compared to lower-middle bilobectomy 7
  • Extended resections worsen outcomes - if chest wall, vascular, or other structures were resected, this independently predicts worse survival (p=0.01) 7
  • Former smoking status may provide modest benefit - in stage I disease, never smokers have better outcomes, but in stage II-III disease, this difference disappears or reverses 8

Realistic Survival Estimate

Synthesizing the evidence for your specific situation (67 years old, former smoker, stage III, bilobectomy):

  • If you had N0-N1 disease (stage IIIA based on T3 tumor): 5-year survival approximately 40-46% 7, 6
  • If you had N2 disease (mediastinal nodes): 5-year survival approximately 30-40% 1, 7
  • If you received adjuvant chemotherapy (cisplatin-based): this is recommended and improves survival for stage IIIA disease 1

Important Caveats

The high perioperative mortality with bilobectomy means many patients don't survive to experience long-term outcomes - the 13% 90-day mortality significantly impacts overall survival statistics 5

Morbidity is substantial - 47.2% of bilobectomy patients experience complications, with mean chest tube duration of 7 days 7

Your age (67) places you in a moderate-risk category - perioperative mortality for lobectomy is 5-6% for ages 60-69, though bilobectomy carries higher risk 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Prognosis of Non-Small Cell Lung Cancer

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

3
Guideline

Stage IIIA N2 Non-Small Cell Lung Cancer Treatment and Management

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

8
Research

The prognostic impact of cigarette smoking on patients with non-small cell lung cancer.

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2011

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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