Comparison of the surgical results of lobectomy with bronchoplasty and pneumonectomy for lung cancer

Abstract

Background The retrospectively compared sleeve lobectomy (SL) and pneumonectomy (PN) for lung cancer in terms of surgical complications and postoperative disease‐free survival, as well as incidence and pattern of recurrent disease. Methods From 1977 to 1993, 29 patients with primary lung cancer underwent sleeve resection at our institution. The pneumonectomy group consisted of 29 cases that had been selected during the same period according to the following criteria: (1) in a tumor located in the upper lobe, there was no invasion within 1 cm from both the carina and the orifice of the middle and the lower lobe bronchus, whereas in a tumor located in the middle or lower lobe, there was no invasion within 1 cm of the orifice of the upper bronchus, (2) there was no invasion to the trunks of the pulmonary vessels, (3) there was no invasion to any other lobes, (4) a complete resection was achieved. Results No differences were observed between the two groups regarding stage, histological population, or age. The incidence of postoperative complications was 13.7% in the SL group (2 cases each of pneumonia and arrythmia), and 24.1% in the PN group (3 bronchopulmonary fistula, 2 bleeding, 1 instance each of arrythmia and acute cardiac failure, and 2 operation‐related deaths) (P < 0.05). The 3‐year disease‐free survival was 65.7% in SL, 58.8% in PN (no statistical significance in the log‐rank test). Recurrent disease was observed in the local regions of three patients in the SL group and six patients in the PN group, and at distant organs of six patients in the SL group and seven in the PN group. Conclusions These findings thus suggest that as a curative treatment, lobectomy with bronchoplasty may be a safer procedure than pneumonectomy for lung cancer. J. Surg. Oncol. 64:32–35 © 1997 Wiley‐Liss, Inc.

For non-small cell lung cancer with T3 (central) disease, sleeve lobectomy or pneumonectomy?

“…have more advanced disease (4)(5)(6)8,10,(12)(13)(14). In order to minimize this selection bias between the two groups, exact same T stage should be the selection criteria.…”

“…SL is technically more demanding than PN, and the decision to select this procedure may be influenced by the surgeons' experience. However, long-term results after SL have demonstrate that it can eradicate cancer to a degree similar to that of PN (5,6,12). And, SL can offer decreased postoperative mortality rates and comparable complication rates (4-6).…”

“…When NSCLC is present with T1-2 disease, SL is more easily to achieve adequate oncologic resection and associated with equal or better survival outcome than PN (6,7,9,16). Clinical studies for comparing the two procedures on T3 central disease were less conducted previously.…”

“…In 1952, Allison performed the first successful right upper lobe sleeve lobectomy (SL) for a patient with bronchogenic carcinoma (4). After comparison with PN, SL has become an accepted and preferred procedure for its similar or better long-term survival as well as lower risk of operative mortality and higher quality of life, regardless of pulmonary function (5)(6)(7)(8)(9)(10)(11)(12)(13).…”

Current Role of Bronchoplastic Procedure for Lung Cancer

“…An interesting meta-analysis (19) including 12 papers (5,6,15,17,18,(20)(21)(22)(23)(24)(25)(26) published between 1996 and 2006 has compared the early and longterm outcome of SL with those of PN. A total of 2984 patients have been included in this analysis, of which 21% undergoing SL and 79% undergoing PN.…”