Sleeve pneumonectomy for lung cancer--survival and complications (single-center experience with 42 patients)

Sleeve pneumonectomy is challenging both from the technical and oncological standpoint. The benefit of induction treatment is still under investigation.

The study included 42 patients with sleeve pneumonectomy for non-small cell lung cancer in an eight-year period. Right sleeve pneumonectomy was performed in 39 patients. Squamous cell and adenocarcinoma were found in 33 (78.5%) and 5 (11.9%) patients, respectively. Overall stage was IIIa for 25 (59.5%) and IIIb for 17 (40.5%) patients, respectively.

Perioperative mortality and morbidity were 16.6% and 35.7%. Leading cause of death was bronchopleural fistula. Five-year survival was 35%. The survival difference between patients with NO+N1 versus N2 lesions was statistically significant (p = 0.01). There were no two-year survivors among patients with N2 lesions. Survival difference between T3 and T4 patients was also significant (p = 0.04). In a multivariate analysis, only T and N components were found significant in terms of prognosis.

Sleeve pneumonectomy should be avoided in patients with N2 lesions confirmed preoperatively. A safe operation can be performed if the surgeon restricts airway resection to a maximum length of 4 cm.