Extended Sleeve Resection for Lung Cancer

Overview of indications for pulmonary sleeve resection

Pulmonary sleeve resection is a complex lung resection and reconstruction surgery mostly performed in patients with centrally located locally invasive lung cancers which often penetrate into central airways and vasculature. This approach was initially used for patients unable to tolerate pneumonectomies, while it is currently also being preferred in patients whose tumors are anatomically suited. Today, thoracic sleeve resections include a wide range of procedures ranging from bronchial and tracheal sleeve resections to carinal sleeve pneumonectomies. In this review, we discuss indications for various types of sleeve resection in the light of current literature.

Extended sleeve-lobectomy for centrally located locally advanced non-small cell lung cancer is a feasible approach to avoid pneumonectomy

Backgrounds

The aim of this study was to report our Institutional experience with extended sleeve lobectomy (ESL) in centrally located non-small cell lung cancer (NSCLC), focusing on technical details, post-operative results, recurrence and survival, to determine whether ESL can be accepted as a favorable alternative procedure to pneumonectomy (PN).

Methods

Twenty-two consecutive patients undergoing ESL for centrally located tumors from January 2014 to June 2019 were prospectively enrolled.

Results

Six (27.3%) patients had been preoperatively considered unfit for PN. Neo-adjuvant chemotherapy was administered in 7 (31.8%) out of the 10 patients that showed a cN2 disease. According to Okada classification, 8 cases of type A ESL (resection of right upper plus middle lobe ± segment 6), one case of type B (resection of left upper lobe + segment 6) and 13 cases of type C (resection of left lower lobe + lingulectomy) ESL were performed. Concomitant pulmonary angioplasty was done in 7 (31.8%) patients. Complete resection was achieved in all patients. There was no postoperative mortality. Major postoperative complications developed in 2 (9.1%) patients (one small anastomotic dehiscence healed in few weeks, one pulmonary embolism). Complete long-term patency of the reconstructed airway was documented in all patients by fiber-optic bronchoscopy. At the median follow-up of 21 months (4–57 months), the recurrence rate was 54.5%, with 4 (18.2%) patients developing a loco-regional recurrence but no endobronchial or perianastomotic recurrence occurred. The overall 3-year survival rate was 45% with a median survival of 33 months.

Conclusions

ESL is a safe and effective procedure that should be considered a favorable alternative to PN whenever it may guarantee a complete resection.