Impact of bronchial anastomosis wrapping on outcomes following sleeve lobectomy

Sleeve lobectomy is widely used for the treatment of centrally located non-small cell lung cancer (NSCLC), aiming to preserve lung function while achieving complete tumor resection. Reinforcement of the bronchial anastomosis with autologous tissues, such as pericardium, has been proposed to reduce postoperative complications. However, the clinical necessity and prognostic significance of this technique remain controversial. This study aimed to evaluate whether wrapping of the bronchial anastomosis with autologous pericardium influences perioperative complications and long-term survival in patients undergoing sleeve lobectomy, thereby providing evidence for optimizing surgical decision-making and individualized management strategies.

In this retrospective study, 91 patients with NSCLC who underwent sleeve lobectomy were included between 2012 and 2017. Group A (29 patients) did not undergo wrapping and group B (62 patients) underwent bronchial wrapping. After propensity score matching, 20 patients were included in each group. Overall survival (OS) was estimated using the Kaplan-Meier method and compared using the Log-rank test.

Wrapping of the bronchial anastomosis did not improve the 30- and 90-day mortality (3.45% and 3.45% vs. 9.68% and 12.9%, P=0.54 and P=0.30, respectively, before matching; 5% and 5% vs. 5% and 5%; P>0.99 and P>0.99, after matching), and there was no significant difference in 5-year OS (55.17% vs. 48.39%, P=0.79, before matching; 60% vs. 65%, P=0.58, after matching) between the two groups.

This study concludes no evidence that bronchial anastomotic wrapping improves either short-term or long-term outcomes. Therefore, routine wrapping is not recommended; however, an individualized surgical strategy based on patient selection should still be considered.