Surgical Outcome After Extended Sleeve Lobectomy in Centrally Located Non-small Cell Lung Cancer.

Background: We primarily aimed to evaluate the operative techniques, clinicopathologic characteristics, and surgical outcomes after extended sleeve lobectomy (ESL). Additionally, we evaluated the feasibility of ESL for centrally located non-small cell lung cancer (NSCLC) compared with pneumonectomy (PN).

Methods: A retrospective review identified 119 patients who underwent pulmonary resections for centrally located NSCLC; of whom, 43 underwent ESLs and 76 underwent PNs. Perioperative morbidity and oncologic outcomes of ESL were analyzed. Postoperative morbidity was evaluated according to the Common Terminology Criteria for Adverse Events version 5.0. Overall survival was evaluated using a Cox proportional hazard model.

Results: According to the classifications of ESL, 10 patients comprised type A, 8 (19%) type B, 16 (37%) type C, and 9 (21%) type D. Pulmonary artery reconstructions were performed in 5 of type A, 8 of type B, 1 of type C, and 1 of type D, and pulmonary vein reconstructions occurred in 3 of type A and 2 of type C. After ESL, 30-day hospital mortality occurred in 1 patient (2.3%), and grade ≥3 morbidities occurred in 13 patients (30%). In particular, bronchial anastomosis/stump fistula was seen in 4 patients (9.3%) after ESL, and blood perfusion disorders due to the presence of thrombi were seen in 4 (9.3%). The 3-year overall survival was significantly better after ESL compared with that after PN (62.8% vs 45.2%, P = .047).

Conclusions: ESLs to preserve lung parenchyma will likely become a promising operative strategy in appropriately selected patients with centrally located NSCLC.