Extended Sleeve Lobectomy After Neoadjuvant Immunochemotherapy for Centrally Located Non-small Cell Lung Cancer

Extended sleeve lobectomy (ESL) is proposed as an effective alternative to pneumonectomy for patients who are not amenable to standard sleeve lobectomy (SSL), which is designed to preserve more lung parenchyma and improve postoperative quality of life. However, the safety and feasibility of ESL after neoadjuvant immunochemotherapy remain unclear.

Between 2019 and 2023, 94 patients with central non-small cell lung cancer (NSCLC) received neoadjuvant immunochemotherapy, followed by pneumonectomy, ESL, or SSL, in 2 high-volume centers. Perioperative, surgical, pathologic, and survival outcomes were meticulously analyzed to evaluate the impact of neoadjuvant immunochemotherapy.

ESL, SSL, and pneumonectomy were performed in 18, 42, and 34 patients, respectively. Patients who underwent ESL had a poorer predicted postoperative forced expiratory volume in 1 second percentage than those who underwent pneumonectomy (P < .01), if pneumonectomy was to be conducted. R0 resection was confirmed in 90 patients (95.7%), including 17 (94.4%) in ESL, 41 (97.6%) in SSL, and 32 (94.1%) in pneumonectomy (P = .72). Postoperative complications were predominantly observed in patients who underwent pneumonectomy (32.4%). Kaplan-Meier curves showed no difference between ESL and SSL. Compared with pneumonectomy, ESL had a longer event-free survival (P = .04).

ESL after neoadjuvant immunochemotherapy is a viable and safe option for selected patients with centrally located NSCLC to avoid pneumonectomy, especially when SSL is insufficient for R0 resection.