Comparative Analysis and Outcomes of Sleeve Resection versus Pneumonectomy

Abstract

To compare the outcome of sleeve resection or complex sleeve resection versus (Vs) pneumonectomy for lung cancer in a single unit. Between 1998 and 2006, 664 lung resections were carried out. There were 129 (19.4%) pneumonectomies and 79 (11.9%) sleeve resections; Twenty one patients (26.5%) underwent a complex sleeve resection. Operative mortality for the sleeve resections (SR) was 2.5% and for the pneumonectomies 8.53%. Overall 5-year survival after SR was 46.8% and after pneumonectomy 37.1%. The survival curves for the 2 procedures after adjusting for risk factors are different. The area under the curve is higher for the SR (Hazard ratio 1.78 C.I.: 0.92-3.46). The 5-year survival for early stages favors SR. The survival for the complex SR was not influenced by the complexity of the procedure but from the TNM stage of each individual case. Multivariate analysis of risk factors affecting survival after surgery showed: male sex Hazard ratio (HR) 1.19, 0.63-2.27(95%CI), Age >63 1.38(HR), 0.78-2.48, Pneumonectomy 1.78(HR), 0.92-3.46 and stage III 4.44(HR), 1.94-10.16(95% CI). For comparative stages survival appears to be better after sleeves, moreover male sex, sleeve resection, age younger that 63 and early TNM stage are positive predictors for survival.

Sleeve lobectomy versus pneumonectomy for non-small cell lung cancer: a meta-analysis

“…Similar results were achieved for differences in survival at 3 years (in six studies [9,10,15,17,18,23], RD 0.15, 95% CI 0.06, 0.24) and 5 years (in twelve studies [9-11,13-18,21-23], RD 0.15, 95% CI 0.09, 0.20). All the estimated combined RD were statistically significant.…”

“…Locoregional recurrences were reported in ten studies [8,10,13-15,18,21,23-25] and resultant data from meta-analysis showed the pooled locoregional recurrence in sleeve lobectomy was 14.44% (104/720) compared with 26.08% (451/1,729) in pneumonectomy, but this was not statistical significant (OR 0.78, 95% CI 0.47, 1.29), as shown in Figure 2.…”

Surgical Techniques and Long-Term Results of Pulmonary Artery Reconstruction in Patients With Lung Cancer

“…In the last 2 decades many authors have reported the positive results and the efficacy of the bronchial sleeve resection [5][6][7][8]. PA resection and reconstruction do not seem to be a real alternative to pneumonectomy because of the discouraging results in complications [9].…”

Current Role of Bronchoplastic Procedure for Lung Cancer

“…Postoperative morbidity and mortality data reveal overall better results for patients undergoing SL with respect to PN (15,18,31,32) (Table 2). These results justify the increasing use of parenchymal sparing procedures for lung cancer also in patients with good cardio-pulmonary function, as observed in the last years.…”

“…Moreover, in the analysis of 5-year survival according to stage and nodal status, SL results in higher survival rates for stages I, II. The survival advantage in stage III patients appears to be limited (17,25,31) (Table 1). In a report by Ludwig (6), sleeve lobectomy results in a more favourable prognosis with a survival advantage in patients with N0, N1 and N2 disease.…”