Local Control of Disease Related to Lymph Node Involvement in Non-Small Cell Lung Cancer After Sleeve Lobectomy Compared With Pneumonectomy

doi:10.1016/j.athoracsur.2004.09.011

The Annals of Thoracic Surgery

Volume 79, Issue 4, April 2005, Pages 1153-1161

Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.

https://doi.org/10.1016/j.athoracsur.2004.09.011 Get rights and content

Background

Increasing evidence has suggested that sleeve lobectomy might be a viable alternative procedure for pneumonectomy in non-small cell lung cancer (NSCLC), including patients with adequate pulmonary reserve. This study was designed to compare the outcomes of the two procedures and to determine adequate surgical indications for each procedure.

Methods

From January of 1989 to December of 1998, sleeve lobectomy was performed in 49 patients, and 200 patients underwent pneumonectomy for NSCLC. By reviewing the computed tomographic scans, bronchoscopic findings, and operative reports, we selected 49 patients on whom sleeve resection could have been performed. The clinical outcomes of the sleeve lobectomies (SL) and pneumonectomies (PN) were analyzed, particularly in relation to nodal status and recurrence patterns.

Results

Operative mortality was 6.1% (3 of 49 patients) in the SL group and 4.1% (2 of 49 patients) in the PN group. Mean follow-up period was 51 months (range, 5 to 149). The overall 5-year survival rate was not substantially different between the two groups (SL: 53.7% vs PN: 59.5%, p = 0.510). Recurrence occurred in 57% (26 of 46 patients) of the SL group and in 30% (14 of 47 patients) of the PN group. The 5-year freedom from recurrence rates were better in the PN group (SL: 45.7% vs PN: 67.9%, p = 0.017). Locoregional recurrences occurred in 32.6% (15 of 46 patients) of the SL group and in 8.5% (4 of 47 patients) of the PN group. In multivariate analysis, performing sleeve resection in patients with a positive N1 lymph node was a significant risk factor for developing locoregional recurrence (p = 0.007).

Conclusions

Although the overall survival rates were similar, sleeve resection resulted in higher locoregional recurrence, particularly in patients with positive N1 lymph nodes. This finding suggests that sleeve resection should be performed in selected patients, such as those without lymph node metastasis.

Section snippets

Patients and Methods

We retrospectively reviewed patients with primary NSCLC who underwent major lung resection at Seoul National University Hospital between January of 1989 and December, 1998. During this period, 749 patients underwent major pulmonary resection for lung cancer. All the patients were evaluated preoperatively by chest roentgenography, chest computed tomographic (CT) scans, pulmonary function tests with or without decreases in lung diffusion for carbon monoxide, fiberoptic bronchoscopy, and bone

Results

Resected lobes in sleeve operations were as follows: right upper lobe in 24, right lower lobe in 2, right middle lobe and right upper lobe in 2, right middle lobe and right lower lobe in 4, left upper lobe in 14, and left lower lobe in 3 patients. For pneumonectomy, right side resections were performed in 29 patients and left side resections in the other 20.

Early postoperative complications occurred in 25 patients (51%) of the SL group and in 17 patients (35%) of the PN group (Table 3).

Comment

The advantage of parenchyma-sparing techniques for patients with limited pulmonary reserve is obvious. However, it is not yet well-documented whether bronchoplastic procedures can offer sufficient treatment for patients with adequate pulmonary reserve. Many papers have compared sleeve resection and pneumonectomy [12]. However, they included all the pneumonectomy cases regardless of tumor status such as location, lymph node involvement, etc. Given that those reports were retrospective studies,

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Citation Excerpt :
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Original articlesGeneral thoracicLocal Control of Disease Related to Lymph Node Involvement in Non-Small Cell Lung Cancer After Sleeve Lobectomy Compared With Pneumonectomy

Background

Methods

Results

Conclusions

Section snippets

Patients and Methods

Results

Comment

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Original articles
General thoracic
Local Control of Disease Related to Lymph Node Involvement in Non-Small Cell Lung Cancer After Sleeve Lobectomy Compared With Pneumonectomy