Outcomes of complex sleeve resections by video-assisted thoracic surgery: single-center study

Complex sleeve resections performed by video-assisted thoracic surgery (VATS) are technically demanding procedures requiring advanced surgical experience. We retrospectively evaluated 21 complex sleeve resections performed by VATS between January 2018 and October 2024. Complex sleeve resections included carinal sleeve pneumonectomy, isolated carinal reconstruction, bronchovascular sleeve lobectomy, vascular sleeve resections, sleeve lingulectomy, distal tracheal reconstruction, and segmental bronchial sleeve resections. Patient selection was based on tumor location, vascular and airway invasion, radiologic resectability, and the feasibility of achieving R0 resection through a minimally invasive approach. The mean operative time was 195 ± 70.2 minutes, and the average blood loss was 340 ± 135.2 mL. Mean postoperative hospital stay was 5.5 ± 1.74 days. Early postoperative morbidity occurred in 4 patients (19%), and postoperative mortality occurred in 1 patient (4.7%). R0 resection was achieved in all malignant cases. In experienced centers with advanced minimally invasive thoracic surgery expertise, complex sleeve resections can be safely performed by VATS with acceptable perioperative morbidity and mortality.