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A Multicenter Retrospective Case-Control Study on Simple vs Extended Sleeve Lobectomies.

Alessio Campisi1, Andrea Dell'Amore2, Eleonora Faccioli2

  • 1Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China; Department of Thoracic Surgery, University and Hospital Trust-Ospedale Borgo Trento, Verona, Italy.

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Summary

Extended sleeve lobectomy (ESL) offers similar survival and complication rates to simple sleeve lobectomy (SSL) for non-small cell lung cancer (NSCLC). Nodal status is the key predictor of overall survival in these lung cancer surgeries.

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Area of Science:

  • Thoracic Surgery
  • Surgical Oncology
  • Pulmonology

Background:

  • Sleeve resection is the standard for centrally located non-small cell lung cancer (NSCLC).
  • Extended sleeve lobectomy (ESL) involves complex bronchoplasty, posing technical challenges compared to simple sleeve lobectomy (SSL).
  • This study directly compares the clinical outcomes of ESL and SSL in NSCLC patients.

Purpose of the Study:

  • To compare the short- and long-term outcomes of extended sleeve lobectomy (ESL) versus simple sleeve lobectomy (SSL) for non-small cell lung cancer (NSCLC).
  • To identify differences in mortality, survival rates, and complication frequencies between ESL and SSL procedures.
  • To determine the impact of tumor characteristics and staging on outcomes for both surgical techniques.

Main Methods:

  • A multicenter, retrospective cohort study involving 1314 patients (2000-2018).
  • Patients underwent either ESL (155) or SSL (1159).
  • Primary endpoints included 30/90-day mortality, overall survival (OS), disease-free survival (DFS), and complication rates.

Main Results:

  • No significant differences in general characteristics, surgical outcomes, or survival (OS, DFS) between ESL and SSL groups.
  • Tumor size was larger in the ESL group (4.72 cm vs 3.81 cm, P < .001).
  • Multivariate analysis identified nodal status as the sole independent predictor of OS.

Conclusions:

  • Extended sleeve lobectomy (ESL) demonstrates comparable short- and long-term outcomes to simple sleeve lobectomy (SSL).
  • Achieving complete (R0) resection is crucial for favorable long-term results.
  • Thorough preoperative staging, including assessment for mediastinal lymph node metastases, is essential for optimal patient outcomes.