Patients with Pulmonary Artery Reconstruction or Double Sleeve Resection Show Inferior Survival than Patients with Bronchial Sleeve Resection for Non-small Cell Lung Cancer

Abstract

Objective

Sleeve lobectomy or resection with pulmonary artery reconstruction is a technique that allows for resection of locally advanced central lung carcinoma, preserving lung function, and is associated with lower morbidity and mortality than pneumonectomy. This survey aimed to assess the long-term survival comparing different types of sleeve lobectomy and identify risk factors affecting survival.

Methods

All consecutive patients who underwent anatomical resection for primary non-small cell lung cancer with bronchial sleeve or pulmonary artery reconstruction in our department between September 2003 and September 2021 were included in this study. Cases with carinal sleeve pneumonectomy were excluded. Data were evaluated retrospectively.

Results

Bronchial sleeve resection was performed in 227 patients, double sleeve resection in 67 patients, and 45 cases underwent isolated lobectomy with pulmonary artery reconstruction. The mean follow-up was 33.5 months. The 5-year survival was 58.5% for patients after bronchial sleeve, 43.2% after double sleeve, and 36.8% after resection with vascular reconstruction. The difference in overall survival of these three groups was statistically significant (p = 0.012). However, the UICC stage was higher in cases with double sleeve resection or resection with vascular reconstruction (p = 0.016). Patients with lymph node metastases showed shorter overall survival (p = 0.033). The 5-year survival rate was 60.1% for patients with N0 and 47% for patients with N1 and N2 status. Induction therapy, vascular sleeve resection, and double sleeve resection were independent adverse predictors for overall survival in multivariate analysis.

Conclusions

Sleeve lobectomy and resection with vascular reconstruction are safe procedures with good long-term survival. However, double sleeve resection and vascular sleeve resection were adverse predictors of survival, possibly due to a higher UICC stage in these patients.

Zusammenfassung

Hintergrund

Zur operativen Behandlung eines lokal fortgeschrittenen Lungenkarzinoms stehen neben der Pneumonektomie verschiedene parenchymsparende Verfahren zur Verfügung, die mit einer niedrigeren Morbidität und Letalität einhergehen. Über eine Resektion mit Bronchusmanschette oder Rekonstruktion der Pulmonalarterie kann eine Pneumonektomie verhindert werden. Ziel dieser Arbeit ist es, zu evaluieren, ob es zwischen den verschiedenen Techniken Unterschiede hinsichtlich Langzeitüberleben gibt und ob sich Risikofaktoren erarbeiten lassen, die das Überleben beeinflussen können.

Patienten und Methoden

In die Auswertung wurden alle Patienten eingeschlossen, die zwischen September 2003 und September 2021 in unserer Klinik aufgrund eines nicht kleinzelligen Lungenkarzinoms behandelt wurden und bei denen eine Bronchusmanschettenresektion oder eine Rekonstruktion der Pulmonalarterie durchgeführt wurde. Patienten mit Manschettenpneumonektomie wurden ausgeschlossen. Die Daten wurden retrospektiv erhoben.

Ergebnisse

Eine Bronchusmanschettenresektion wurde bei 227 Patienten durchgeführt. Eine Doppelmanschettenresektion erfolgte bei 67 Patienten und in 45 Fällen erfolgte eine isolierte Rekonstruktion der Pulmonalarterie. Das mittlere Follow-up lag bei 33,5 Monaten. Das 5-Jahres-Überleben lag bei 58,5% bzw. 43,2% für Patienten nach Bronchusmanschetten- bzw. Doppelmanschettenresektion und 36,8% nach Resektion mit pulmonalarterieller Rekonstruktion (p = 0,012). Patienten nach Doppelmanschettenresektion oder alleiniger Gefäßrekonstruktion hatten ein höheres UICC-Stadium (p = 0,016).
Patienten mit Lymphknotenmetastasen hatten ein kürzeres Gesamtüberleben (p = 0,033). Das 5-Jahres-Überleben von Fällen mit einem N0-Status lag bei 60,1%, während das von Patienten mit Metastasen in N1- oder N2-Lymphknoten bei 47% lag. Neben der Induktionstherapie stellten auch Gefäßmanschetten und Doppelmanschetten einen unabhängigen negativen Prädiktor für das Gesamtüberleben in der multivariaten Analyse dar.

Schlussfolgerung

Parenchymsparende Lungenresektionen sind sichere Verfahren mit einem guten Langzeitüberleben. Die Notwendigkeit einer Doppelmanschettenresektion und einer Pulmonalarterienrekonstruktion war mit einem schlechteren Langzeitüberleben assoziiert, möglicherweise aufgrund des höheren UICC-Stadiums dieser Patienten.

Keywords

non-small cell lung cancer - sleeve lobectomy - pulmonary artery reconstruction - double sleeve lobectomy

Schlüsselwörter

nicht kleinzelliges Lungenkarzinom - Bronchusmanschettenresektion - Gefäßmanschettenresektion - Manschettenlobektomie

Publication History

Received: 24 March 2024

Accepted after revision: 17 June 2024

Article published online:
03 September 2024

• References

• 1 Postmus PE, Kerr KM, Oudkerk M. et al. Early and locally advanced non-small cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28 (Suppl. 4) iv1-iv21
• 2 Menna C, Rendina EA, D’Andrilli A. Parenchymal Sparing Surgery for Lung Cancer: Focus on Pulmonary Artery Reconstruction. Cancers (Basel) 2022; 14: 4782
• 3 Koryllos A, Stoelben E. Uniportal video-assisted thoracoscopic surgery (VATS) sleeve resections for non-small cell lung cancer patients: an observational prospective study and technique analysis. J Vis Surg 2018; 4: 16
• 4 Liu C, Yang Z, Guo C. et al. Lobectomy with pulmonary artery angioplasty for lung cancer using video-assisted thoracic surgery versus open thoracotomy: a retrospective propensity matched analysis. Transl Lung Cancer Res 2021; 10: 3943-3956
• 5 Gu C, Pan X, Chen Y. et al. Short-term and mid-term survival in bronchial sleeve resection by robotic system versus thoracotomy for centrally located lung cancer. Eur J Cardiothorac Surg 2018; 53: 648-655
• 6 Li Z, Chen W, Xia M. et al. Sleeve lobectomy compared with pneumonectomy for operable centrally located non-small cell lung cancer: a meta-analysis. Transl Lung Cancer Res 2019; 8: 775-786
• 7 Vogt-Moykopf I, Toomes H, Heinrich S. Sleeve resection of the bronchus and the pulmonary artery for pulmonary lesions. Jpn J Surg 1982; 12: 311-320
• 8 Watanabe I, Hattori A, Fukui M. et al. Pulmonary artery reconstruction for non-small cell lung cancer: Surgical management and long-term outcomes. J Thorac Cardiovasc Surg 2022; 164: 1200-1207
• 9 Wu L, Wang H, Cai H. et al. Comparison of Double Sleeve Lobectomy by Uniportal Video-Assisted Thoracic Surgery (VATS) and Thoracotomy for NSCLC Treatment. Cancer Manag Res 2019; 11: 10167-10174
• 10 Deslauriers J, Gaulin P, Beaulieu M. et al. Long-term clinical and functional results of sleeve lobectomy for primary lung cancer. J Thorac Cardiovasc Surg 1986; 92: 871-879
• 11 Ma Z, Dong A, Fan J. et al. Does sleeve lobectomy concomitant with or without pulmonary artery reconstruction (double sleeve) have favorable results for non-small cell lung cancer compared with pneumonectomy? A meta analysis. Eur J Cardiothorac Surg 2007; 32: 20-28
• 12 D’Andrilli A, Maurizi G, Ciccone AM. et al. Long-segment-pulmonary artery resection to avoid pneumonectomy: long-term results after prosthetic replacement. Eur J Cardiothorac Surg 2018; 53: 331-355
• 13 Madariaga MLL, Geller A, Lanuti M. et al. Pulmonary Artery Resection During Lung Resection for Malignancy. Ann Thorac Surg 2019; 108: 1692-1700
• 14 Ludwig C, Riedel R, Schnell J. et al. Inhalation with Tobramycin to improve healing of tracheobronchial reconstruction. Eur J Cardiothorac Surg 2009; 35: 797-800
• 15 Rendina EA, Venuta F, De Giacomo T. et al. Reconstruction of the pulmonary artery by a conduit of autologous pericardium. J Thorac Cardiovasc Surg 1995; 110: 867-868
• 16 Ludwig C, Stoelben E. A new classification of bronchial anastomosis after bronchial sleeve lobectomy. J Thorac Cardiovasc Surg 2012; 144: 808-812
• 17 Thomas CP. Conservative resection of the bronchial tree. J R Coll Surg Edinb 1956; 1: 169-186
• 18 Nagayagu T, Matsumoto K, Tagawa T. et al. Factors affecting survival after bronchoplasty and broncho-angioplasty for lung cancer: a single institutional review of 147 patients. Eur J Cardiothorac Surg 2006; 29: 585-590
• 19 Vannucci J, Matricardi A, Potenza R. et al. Lobectomy with angioplasty: which is the best technique for pulmonary artery reconstruction. J Thorac Dis 2018; 10 (Suppl. 16) S1892-S1898
• 20 Bao Y, Jiang C, Wan Z. et al. Feasibility of double sleeve lobectomy after neoadjuvant chemotherapy in patients with non-small cell lung cancer. Interact CardioVasc Thorac Surg 2022; 35: ivac103
• 21 Gómez-Caro A, Boada M, Reguart N. et al. Sleeve lobectomy after induction chemoradiotherapy. Eur J CardioThorac Surg 2012; 41: 1052-1058
• 22 Koryllos A, Lopez-Pastorini A, Zalepugas D. et al. Bronchus anastomosis healing depending on type of neoadjuvant therapy. Ann Thorac Surg 2020; 109: 879-886
• 23 Jaradeh M, Vigneswaran WT, Raas W. et al. Neoadjuvant Chemotherapy vs Chemoradiation Therapy Followed by Sleeve Resection for Resectable Lung Cancer. Ann Thorac Surg 2022; 114: 2041-2047
• 24 Goldstraw P, Chansky K, Crowley J. et al. The IASCL Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016; 11: 39-51
• 25 Ludwig C, Stoelben E, Olschewski M. et al. Comparison of morbidity, 30-day mortality, and long-term survival after pneumonectomy and sleeve lobectomy for non-small cell lung carcinoma. Ann Thorac Surg 2005; 79: 968-973
• 26 Venuta F, Ciccone AM, Anile M. et al. Reconstruction of the pulmonary artery for lung cancer: long-term results. J Thorac Cardiovasc Surg 2009; 135: 1185-1189
• 27 Schiavon M, Comacchio GM, Mammana M. et al. Lobectomy with artery reconstruction and Pneumonectomy for Non-Small Cell Lung Cancer: A Propensity Score Weighting Study. Ann Thorac Surg 2021; 112: 1805-1813