Extended sleeve lobectomy after neoadjuvant chemo-immunotherapy: postoperative outcomes differ by surgical side

Centrally located non-small cell lung cancer (NSCLC) has traditionally been managed by pneumonectomy (PN), while sleeve lobectomy has emerged as a parenchyma-sparing alternative. With neoadjuvant chemo-immunotherapy now standard for locally advanced NSCLC, the role of extended sleeve lobectomy in this setting remains unclear. The study evaluated whether extended sleeve lobectomy (ESL) could bring benefits to the NSCLC patients eligible for the procedure after neoadjuvant chemo-immunotherapy.

Three hundred and thirty-five centrally located NSCLC patients who underwent sleeve lobectomy or PN following neoadjuvant immunotherapy plus chemotherapy in Shanghai Pulmonary Hospital were retrospectively reviewed. The population was divided into three groups: the ESL, the simple sleeve lobectomy (SSL), and the PN groups. Short-term perioperative outcomes, event-free survival (EFS), and overall survival were compared among the three groups in the overall, left-sided, and right-sided cohorts, respectively.

In the overall cohort, baseline characteristics showed no significant differences among the three groups, except for the surgical side (P<0.001). The ESL group had prolonged operation time, longer drainage time, and better EFS relative to the PN group. Subsequently, the effectiveness of surgical procedures was evaluated on the left and right sides, respectively. On the right, the complication rate of the PN group is higher than in the ESL and SSL groups (P=0.054). In contrast, for left-sided procedures, no significant difference in complication rates was observed among the three groups (P=0.49). Multivariable logistic regression showed that, on the right side, ESL was independently associated with lower odds of postoperative complications compared with PN (P=0.02), whereas no significant association was noted on the left side. Comparable EFS was observed between the ESL and SSL groups on both sides. Compared to the PN group, patients in the ESL group showed a favorable EFS trend (P=0.06) on the right side, whereas no significant difference (P=0.50) was observed on the left side.

ESL might bring benefits to patients with NSCLC on the right surgical side after neoadjuvant chemo-immunotherapy compared to PN, while the advantage was not obvious when operating on the left side.