Is sleeve lobectomy safe after induction therapy?—a systematic review and meta-analysis

Abstract

Background: Sleeve lobectomy (SL) is a lung-sparing procedure, which is accepted as a valid operation for centrally-located advanced tumors. These tumors often require induction treatment by chemotherapy and/ or radiotherapy to downstage the disease and thus facilitate subsequent surgery. However, induction therapy may potentially increase the risk of bronchial anastomotic complications and related morbidity. This metaanalysis aims to determine the impact of induction therapy on the outcomes of pulmonary SL. Methods: We compared studies of patients undergoing SL or bilobectomy for non-small cell lung cancer (NSCLC) with and without induction therapy. Outcomes of interest were in-hospital mortality, morbidity, anastomosis complication and 5-year survival. Odds ratio (OR) were computed following the Mantel-Haenszel method. Results: Ten studies were included for a total of 1,204 patients. There was no statistical difference for between patients who underwent induction therapy followed by surgery and patients who underwent surgery alone in term of post-operative mortality (OR: 1.80, 95% confidence interval (CI): 0.76-4.25, P value =0.19) and morbidity (OR: 1.17, 95% CI: 0.90-1.52, P value =0.237). Anastomosis related complications rate were 5.2% and appears increased after induction therapy with a statistical difference close to the significance (OR:1.65, 95% CI: 0.97-2.83, P value =0.06). Patients undergoing surgery alone showed better survival at 5 years (OR: 1.52, 95% CI: 1.15-2.00, P value =0.003).Conclusions: SL following induction therapy can be safely performed with no increase of mortality and morbidity. However, the need for induction therapy before surgery is associated with increased anastomotic complications and poorer survival prognosis at 5 years.

Sleeve lobectomy in patients with non-small-cell lung cancer: a report from the European Society of Thoracic Surgery database 2021

“…Mortality was 30.4% in this group of patients, underlining the importance of recognizing and promptly managing this complication. In a recent metaanalysis of 1204 sleeve resections, bronchial complications were reported in 63 patients (5.2%) [13]. However, late stenoses were included in the analysis, a complication that was not analysed in our series.…”

“…However, the VATS approach requires advanced surgical skills and should be performed by experienced surgeons in high-volume centres. In parallel, induction therapy by chemotherapy or radiotherapy has been used extensively to manage non-small-cell lung cancers (NSCLC), notably before a sleeve lobectomy, to reduce the size of the tumour and avoid pneumonectomy [7,11], but the impact of neoadjuvant treatment before a bronchoplastic procedure remains controversial, notably regarding airway healing [12,13].…”

Clinical Efficacy of Single-Port Thoracoscopic Lobectomy versus Three-Port Thoracoscopic Lobectomy for Lung Cancer

“…Video-assisted thoracoscopic lobectomy features significant advantages such as minimally invasive and mild pain, which can effectively shorten the hospital stay of patients [ 7 ] and reduce the incidence of postoperative complications. The National Comprehensive Cancer Network guidelines (NCCN) recommended thoracoscopic lobectomy as the standard surgical approach for the treatment of lung cancer in 2006 in light of its remarkable efficacy [ 8 ], and in the previous decade, different branches of the technique were developed from the previous four-port and three-port surgical approaches to the two-port and single-port ones. Currently, the three-port approach is the conventional choice for thoracoscopic radical pneumonectomy [ 9 ], but the continuous optimization of medical technology has also confirmed the effectiveness of the single-port approach.…”