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Eur J Cardiothorac Surg 2006;29:276-280
© 2006 Elsevier Science NL

Comparison of surgical results after pneumonectomy and sleeve lobectomy for non-small cell lung cancer.

Trends over time and 20-year institutional experience

^a Department of General Thoracic Surgery, National Hospital Organization, Toneyama National Hospital, Toneyama 5-1-1, Toyonaka, Osaka 560-8552, Japan
^b Department of Anesthesiology, National Hospital Organization, Toneyama National Hospital, Toyonaka, Osaka 560-8552, Japan
^c Department of General Thoracic Surgery, Osaka University, Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka 565-0847, Japan
^d National Hospital Organization, Department of General Thoracic Surgery, Kinkichuo Chest Medical Center, Sakai, Osaka 591-8555, Japan

Received 21 October 2005; received in revised form 5 December 2005; accepted 12 December 2005.

^_* Corresponding author. Tel.: +81 6 6853 2001; fax: +81 6 6850 1750. (Email: stakeda{at}toneyama.hosp.go.jp).

Objective: Sleeve lobectomy is a lung-saving procedure for central tumors for which the alternative is pneumonectomy. The purpose of this study was to report the clinical characteristics, operative results, survival, and late outcomes over 20 years in patients who underwent sleeve lobectomy and pneumonectomy at our institution. Methods: There were 62 patients who underwent sleeve lobectomy (SL group) and 110 who underwent pneumonectomy (PN group). Comparisons of the demographics, morbidity, and survivals between the groups were performed by unpaired t-test, ²-test, and log-rank test. Results: Patients who underwent a pneumonectomy showed a significantly advanced pathological stage, and a larger tumor size than those who received a sleeve lobectomy, whereas there were no significant differences in histology, ratio of combined resection and induction therapy, or total morbidity. There were three in-hospital deaths (4.8%) in the SL group and four (3.6%) in the PN group. Local relapse and distant recurrence incidence were similar between the two groups. The 5-year-survival rates of the SL and PN groups were 54% and 33%, respectively (p < 0.0001). However, there were no differences in 5-year survivals in patients with pathological stage I/II (SL, 59% vs PN, 63%) and those who received induction therapy (SL, 22% vs PN, 52%) between the groups. Conclusions: Both pneumonectomy and sleeve lobectomy were performed with an acceptable risk of operative mortality and satisfactory 5-year survival rate. The indication of pneumonectomy is aimed to perform a curative resection for locally advanced lung cancer, particularly after induction therapy that is otherwise unresectable, and the selected patients will likely benefit from a complete resection.

Key Words: Pneumonectomy • Sleeve lobectomy • Morbidity and mortality • Induction therapy

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