Long-term results after bronchial sleeve resection

In bronchial sleeve resections part of the bronchial wall is removed followed by the creation of a bronchial end-to-end anastomosis. The cylindrical part that is removed is called a "sleeve". In this way functional lung parenchyma can be saved in centrally located bronchogenic carcinomas while performing an oncologically valid operation. However, controversial results were reported in literature regarding long-term survival after bronchial sleeve resection especially in relation to nodal status. In a series of 145 patients undergoing bronchial sleeve resection for a bronchogenic tumor in the Antonius Hospital, Nieuwegein, the Netherlands, long-term results were studied. A univariate and multivariate analysis were performed to determine significant factors related to survival. Follow-up was updated until 1999, so a minimum follow-up of 10 years was obtained for surviving patients. For the entire group 5, 10 and 15-year survival rates were 45, 35 and 23%, respectively. Median survival time was 52 +/- 10 months. Five- and 10-year survival rates for the 71 patients with N0 disease were 62% and 53%, respectively; for the 58 patients with N1 disease, 29% and 21%; and for the 16 patients with N2 disease, 31% and 6%. There was a highly significant difference in survival between patients with N0 and N1 (p = 0.001) or N2 (p < 0.001) disease. The difference between N1 and N2 disease reached statistical significance (p = 0.047). A Cox multivariate regression analysis showed only nodal stage and patient age to be significant factors in relation to survival. To improve long-term survival adjuvant treatment should be considered in case of N1 or N2 disease as most of these patients die of distant metastases.