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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.
The Annals of Thoracic Surgery
|January 21, 2024
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.
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.
