Extended sleeve lobectomy has same surgical outcome when compared with conventional lobectomy in patients with lung cancer

Background:

No significant data is available to assess whether extended sleeve lobectomy (extended-SL) can be considered comparable to conventional lobectomy (CL) in terms of surgical outcome. The purpose of this study was to compare surgical and oncological outcomes of extended-SL with CL in patients with lung cancer.

Material and method:

Between 2000 and 2015, 568 patients with lung carcinoma who underwent open CL (defined as only one lobe resection without another lobe and/or organ resections; chest wall, diaphragm, pericardium, etc.) and 187 patients with lung carcinoma who underwent sleeve lobectomy were analyzed. Sleeve lobectomy was divided into two subgroups; standard-SL (bronchial SL, n = 106) and extended-SL (n = 81) (defined as bronchial sleeve resection together with another surgical intervention; bronchovascular SL, n = 40; vascular SL, n = 26; atypical bronchoplasty with resection of more than one lobe, n = 12; bronchial SL+chest wall resection, n = 3).

Result:

Age, gender, BMI, pack/years, and comorbidity did not differ between CL and extended-SL. Extended-SL group had more COPD patients (25.9% vs. 12.5%, p = 0.001), neoadjuvant treatment (39.5% vs. 12.0%, p < 0.001), advanced stage NSCLC (53.2% vs. 33.1%, p = 0.001), and low preopFEV1 (77.2% vs. 84.3%, p = 0.004) than CL group. The overall surgical mortality (in hospital or 30-days) was 2.6% (n = 20). It was 2.8% for CL, 2.8% for extended-SL, and 1.2% bronchial-SL (p = 0.4). Postoperative complications occurred in 34.9% of CL and 39.5% of extended-SL group (p = 0.4). Pulmonary complication rate was similar between the groups (24.1% for CL, 27.2% for extended-SL, p = 0.5). The five-year survival in the CL group was 57.1%, 57.6% for bronchial-SL group, and 56.2% for extended-SL group (p = 0.9) (Figure 1). Multivariate analysis showed that TNM stage (p < 0.001) and N status (p < 0.001) were significant independent negative prognostic factors for survival.

Fig. 1: Survival curves for surgery types; 5-year survival in the Conventional-L group was 57.1%, 57.6% for Bronchial-SL group, and 56.2% for Extended-SL group

Conclusion:

Extended-SL had comparable outcome to conventional open lobectomy although extended-SL had advanced stage, low preopFEV1 and more COPD patients.