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

Abstract

OBJECTIVES For centrally located lung tumours, sleeve lobectomy is preferred over pneumectomy. We report on surgical practices and peri-operative outcomes of sleeve resections based on the European Society of Thoracic Surgeons database. METHODS We retrieved data of patients undergoing sleeve lobectomy or bilobectomy from 2007 to 2021. We evaluated baseline characteristics, surgical approach, neo-adjuvant treatments, morbidity and post-operative outcomes of open and video-assisted thoracic surgery (VATS) procedures. RESULTS In total, 1652 patients (median age: 63; f/m: 446/1206) underwent sleeve lobectomy (n = 1536) or bilobectomy (n = 116) by open thoracotomy (n = 1491; 90.2%) or VATS (n = 161; 9.8%) with thoracotomy conversion rate of 21.1% (n = 34). 398 (24.1%) received neo-adjuvant treatment. Overall morbidity and 30-day mortality were 40.6% and 2.2% respectively. Bronchial anastomotic complications occurred in 29 patients (1.8%) with conservative treatment in 6 cases (20.7%) and operative management in 23 (79.3%). On multivariable analysis, factors of elevated risk of cardiopulmonary complications were BMI < 20 (OR: 2.26; P < 0.001) and bilobectomy (OR : 2.28, p < 0.001). Age <60 (OR. 0.71, p = 0.013), female sex (OR: 0.54, p < 0.001) and VATS (0.64, p < 0.001) were associated with decreased risk. Neo-adjuvant treatment was not associated with increased risks of cardiopulmonary complications (OR: 1.05; p = 0.664). Compared to open thoracotomy, VATS was associated with significantly decreased overall morbidity (30.4% vs 41.7%, p = 0.006) and length of stay (median: 5 days vs 8 days; p < 0.001). CONCLUSION Sleeve lobectomies can be safely performed after neo-adjuvant treatment. VATS approach fosters shorter length of stay and decreased morbidity.

Minimally invasive sleeve lobectomy for centrally located lung cancer: A real-world study with propensity-score matching

“…On the other hand, intraoperative blood loss and postoperative amount of drainage in the MIS group were significantly less than in the Open group, indicating that MIS sleeve lobectomy could render uncompromised recovery and carries with it certain benefits in selected patients with centrally located NSCLC. Recently a database study showed that the VATS approach was associated with shorter length of stay and decreased morbidity in sleeve lobectomy cases (33), which was consistent with our findings.…”

“…In this study, there were fourteen cases intended to receive MIS but were converted to open surgery. The conversion rate was 13.6%, which was similar to the 4.5%–21.1% conversion rates in the other published MIS sleeve lobectomy studies ( 28 – 30 , 33 ). Unfortunately, none of those studies reported the surgical outcomes in converted cases.…”

Minimally invasive sleeve lobectomy: it is important to pass excellent techniques to the next generation

“…Conversion rates in two recent studies that included more than 100 patients with VATS sleeve lobectomy were 2.9% and 4.5%, respectively (2,3). In contrast, in recent studies using the European Society of Thoracic Surgeons (ESTS) database and the U.S. National Cancer Data Base (NCDB), these values were 24.5% and 20.5%, respectively (11,12). Thus, conversion rates vary among previous studies.…”

“…In the ESTS database study, 1,652 patients with sleeve lobectomy from 2007 to 2021 were evaluated. The data were collected from 270 thoracic surgery units in 25 European countries ( 11 ). The number of sleeve lobectomy procedures performed at each institute per year may be small.…”

The impact of neoadjuvant therapy on postoperative outcomes following sleeve lobectomy for locally advanced non-small cell lung cancer: a call for future investigation

“…The integration of neoadjuvant therapy into the treatment paradigm has proven to downstage tumors, increase complete resection rates, and improve long-term patient outcomes after surgical resection ( 4 ). Importantly, several contemporary small series and case reports encompassing diverse patient cohorts have consistently demonstrated that sleeve lobectomy can be safely performed following neoadjuvant treatment ( 5 - 7 ). Despite this, whether new neoadjuvant modalities increase surgical risks or postoperative complications after sleeve lobectomy is still a question that remains to be definitively answered in larger patient cohorts.…”