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Eur J Cardiothorac Surg 2007;31:95-102. doi:10.1016/j.ejcts.2006.10.031
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Morbidity, mortality, and long-term survival after sleeve lobectomy for non-small cell lung cancer

Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, Le Plessis Robinson, France

Received 8 September 2006; received in revised form 11 October 2006; accepted 23 October 2006.

^_* Corresponding author. Address: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, 133 Avenue de la Resistance, 92350 Le Plessis Robinson, France. Tel.: +33 140948573; fax: +33 146308562. (Email: byildizeli{at}marmara.edu.tr).

Objective: Sleeve lobectomy is a widely accepted procedure for central tumors for which the alternative is pneumonectomy. The purpose of this study is to assess operative mortality, morbidity, and long-term results of sleeve lobectomies performed for non-small cell lung carcinoma (NSCLC). Methods: A retrospective review of 218 patients who underwent sleeve lobectomy for NSCLC between 1981 and 2005 was undertaken. There were 186 (85%) men and 32 women with a mean age of 61.9 years (range, 19–82 years). Eighty patients (36.6%) had a preoperative contraindication to pneumonectomy. Right upper lobectomy was the most common operation (45.4%). Vascular sleeve resection was performed in 28 patients (12.8%) and was commonly associated with left upper lobectomy (n = 20; 9.1%; p = 0.0001). The histologic type was predominantly squamous cell carcinoma (n = 164; 75%), followed by adenocarcinoma (n = 46; 21%). Resection was incomplete in nine (4.1%) patients. Results: There were nine operative deaths; the operative mortality and the morbidity rates were 4.1% and 22.9%, respectively. A total of 14 (6.4%) patients presented with bronchial anastomotic complications: two were fatal postoperatively, seven patients required reoperation, three required a stent insertion, and two were managed conservatively. Multivariate analysis showed that compromised patients (p = 0.001), current smoking (p = 0.01), right sided resections (p = 0.003), bilobectomy (p = 0.03), squamous cell carcinoma (p = 0.03), and presence of N1 or N2 disease (p = 0.01) were risk factors for mortality and morbidity. Follow-up was complete in 208 patients (95.4%). Overall 5-year and 10-year survival rates were 53% and 28.6%, respectively. After complete resection, recurrence was local in 10 patients, mediastinal in 20, and distant in 25. By multivariate analysis, two factors significantly and independently influenced survival: nodal status (N0–N1 vs N2; p = 0.01) and the stage of the lung cancer (stage I–II vs III, p = 0.02). Conclusions: For patients with NSCLC, sleeve lobectomy achieves local tumor control, even in patients with preoperative contraindication to pneumonectomy and is associated with low mortality and bronchial anastomotic complication rates. Postoperative complications are higher in compromised patients, smokers, N disease, right sided resections, bilobectomies, and squamous cell cancers. The presence of N2 disease and stage III significantly worsen the prognosis.

Key Words: Sleeve lobectomy • Bronchoplastic resection • Lung cancer • Complications • Survival

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