Sleeve lobectomy as an alternative to pneumonectomy in patients with operable lung cancer
Abstract:
In many patients with non-small cell lung cancer (NSCLC), pneumonectomy is still the only choice of surgical treatment. Pneumonectomy is associated with the increased risk of postoperative complications and higher mortality. Late results are affected by progressive deterioration of the quality of life. In some patients, especially with central location of the tumor the sleeve lobectomy can be an alternative to pneumonectomy. However, there are some doubts about the higher risk of local recurrence. The aim of the study was to assess the early and late results of sleeve lobectomy in patients with NSCLC treated surgically. The study group consisted of 107 patients subjected to surgery due to NSCLC between 2001 and 2009. There were 89 male and 18 female patients, aged between 35 and 78 years (mean age: 65 years). Surgery was preceded by routine diagnostic and staging procedures. Statistical analysis was based on the Statistica 6.0 software.The following sleeve lobectomies were performed: 71 right upper, 29 left upper, 5 left lower lobectomies, one inferior bilobectomy and one upper bilobectomy. Twelve patients were subjected to left upper sleeve lobectomy with partial resection and reconstruction of the pulmonary artery. Squamous cell carcinoma (SCC) was the most common type of histology. Most patients were classified as stage IB and IIB. Perioperative mortality in the entire study population was 1.8%. The most frequent complications were as follows: supraventricular arrhythmias (11.2%) and atelectasis of the operated lung (10.3%). The five-year survival after surgery was 56.1%. Local recurrence was observed in 10 patients (9.3%). Statistical analysis demonstrated that T stage and postoperative chemotherapy were significant factors influencing long-term survival. Multivariate analysis showed that T stage was the only factor influencing the long-term survival. Sleeve lobectomy is a good alternative to pneumonectomy in selected patients with NSCLC. Although it is considered as technically difficult, it is characterized by lower risk of death during the perioperative period, lower percentage of significant postoperative complications and better quality of life after the operation.