Original article: general thoracic
Sleeve lobectomy for bronchogenic cancers: factors affecting survival

Presented at the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.
https://doi.org/10.1016/S0003-4975(02)03792-XGet rights and content

Abstract

Background. Sleeve lobectomy is a parenchyma-sparing procedure that is particularly valuable in patients with cardiac or pulmonary contraindications to pneumonectomy. The purpose of this study is to report our experience with sleeve lobectomy for bronchogenic cancer and to investigate factors associated with long-term survival.

Methods. Between January 1981 and June 2001, 169 patients underwent sleeve lobectomy for non-small-cell lung cancer (n = 139) or carcinoid tumor (n = 30), including 61 with a preoperative contraindication to pneumonectomy. Mean age was 59 ± 14 years (range, 19 to 82 years). Vascular sleeve resection was performed in 11 patients. The remaining bronchial stump contained microscopic disease in 7 patients.

Results. Major bronchial anastomotic complications occurred in 6 (3.6%) patients: one was fatal postoperatively, three required reoperation, and two were managed conservatively. In the non-small-cell lung cancer group, operative mortality was 2.9% (4 of 139), and overall 5-year and 10-year survival rates were 52% and 28%, respectively. Six patients experienced local recurrence after complete resection. By multivariate analysis, two factors significantly and independently influenced survival: nodal status (N0 or N1 versus N2; p = 0.01) and microscopic invasion of the bronchial stump (p = 0.02). In the carcinoid tumor group, there were no operative deaths, and overall 5-year and 10-year survival rates were 100% and 92%, respectively.

Conclusions. Sleeve lobectomy achieves local tumor control and is associated with low mortality and bronchial anastomotic complication rates. Long-term survival is excellent for carcinoid tumors. For patients with non-small-cell lung cancer, N2 disease or incomplete resection is associated with a worse prognosis; outcome is not affected by presence of a preoperative contraindication to pneumonectomy.

Section snippets

Patients and methods

Between January 1981 and June 2001, 169 patients underwent sleeve lobectomy for bronchogenic cancer at the Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, France. There were 135 (80%) men and 34 women, with a mean age of 58.7 ± 13.5 years (range, 19 to 82 years).

Two thirds of the 169 sleeve lobectomies were performed in or after January 1992. For the last decade, sleeve lobectomy has been the procedure of choice, when technically feasible,

Sleeve lobectomy for non-small-cell lung cancer (n = 139)

Permanent sections showed squamous cell cancer in 109 patients (78%) and nonsquamous cancer in 30 patients (22%: adenocarcinoma, n = 25; large-cell undifferentiated carcinoma, n = 3; and adenosquamous carcinoma, n = 2). Three patients underwent induction chemotherapy for N2 disease. According to the TNM classification [12], 54 patients (39%) were stage I (17 IA and 37 IB), 47 (34%) were stage II (5 IIA and 42 IIB), 37 (26%) were stage III (37 IIIA), and 1 was stage IV with NSCLC and a

Comment

Sleeve resection is the procedure of choice for nonmalignant bronchial disease 2, 13 and has become the standard surgical treatment in selected patients with bronchogenic tumor and functional test results that contraindicate pneumonectomy 8, 14. Because this technically demanding procedure was associated in some reports with high rates of operative mortality [15] or bronchial anastomotic complications [8], debate continues to surround its use for resecting bronchogenic tumors in patients who

Cited by (0)

View full text