Lung sparing surgery by means of extended broncho-angioplastic (sleeve) lobectomies

To determine the morbidity, mortality and survival of sleeve lobectomy procedures compared to simple broncho-angioplasty procedures.

A total of 535 patients diagnosed with bronchogenic cancer between September 2005 and May 2010 who fulfilled the criteria of clinical, oncological and functional operability were treated in our unit. Unresectable central tumours (n=95) using simple lobectomy were scheduled for broncho-angioplasty techniques and a pneumonectomy in those where this was impossible.

A total of 58 (11%) were performed, 46 simple broncho-angioplastic lobectomies (SBAL) and 12 extended broncho-angioplastic lobectomies (EBAL). In the SBAL group there were 32 bronchial (70%) and 7 (15%) bronchovascular reconstructions and only vascular (15%). In the EBAL group, 8 (66.7%) were bronchial and 4 (33.3%) were bronchovascular reconstructions. The most common type of resection was the right upper lobe (RUL)+segment 6 in five (41%) cases, followed by RUL+middle lobe. There were 2 (3%) deaths in the SBAL group. There was 34% morbidity in the SBAL and 33% in the EBAL group (P>0.05). Fifteen patients received neoadjuvant chemo-radiotherapy treatment, due to histologically confirmed cN2; however, the number of complications was not significantly higher. No risk factors were detected in any variable studied that would affect EBAL compared to the SBAL group (P>0.05). The patients in both groups with a higher morbidity were pN1, located in the left upper lobe and associated with vascular reconstruction (P<0.05). The overall survival at 5 years was 61.6%, SBAL (61%) and EBAL (68.9%) with no differences between groups (P>0.05).

EBALs are technically more demanding procedures, but do not increase morbidity or mortality compared to simple broncho-angioplasty techniques, and with a similar survival.