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

Abstract

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 fiberoptic 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.

A Retrospective Study of Effectiveness of Thoracoscopic Lobectomy and Segmentectomy in Patients with Early-Stage Non-Small-Cell Lung Cancer

“…Lobectomy and lymph node dissection are the standard treatment approaches for early-stage NSCLC. However, this finding is not consistent with the minimally invasive concept of achieving better outcomes with less trauma [ 8 ]. In recent years, segmentectomy has been used to treat early-stage NSCLC.…”

Long-Term Survival after Extended Sleeve Lobectomy (ESL) for Central Non-Small Cell Lung Cancer (NSCLC): A Meta-Analysis with Reconstructed Time-to-Event Data

“…The characteristics of the incorporated studies are demonstrated in Table 1. From the 126 articles that were retrieved originally, nine studies [4,[10][11][12][13][14][15][16][17] were included in the qualitative and seven in the quantitative analysis [10][11][12][13][14][15][16]. The level of agreement between the reviewers was "almost perfect" (kappa = 0.844; 95% CI: 0.672, 1.000).…”

“…The level of agreement between the reviewers was "almost perfect" (kappa = 0.844; 95% CI: 0.672, 1.000). In addition, the study design was prospective in four studies [10,12,15,16] and retrospective in five studies [4,11,13,14,17]. Moreover, the incorporated studies were conducted in Japan [4,11,13,17], France [10], Italy [12,15], Korea [14], and China [16], and were published between 1999 and 2022.…”

“…In addition, the study design was prospective in four studies [10,12,15,16] and retrospective in five studies [4,11,13,14,17]. Moreover, the incorporated studies were conducted in Japan [4,11,13,17], France [10], Italy [12,15], Korea [14], and China [16], and were published between 1999 and 2022. The ESL and PN patient populations ranged from 15 to 63 and from 15 to 76 patients, respectively.…”

“…The total study population was 431 patients; 259 patients underwent ESL and 172 patients underwent PN. The Okada classification was implemented in two studies [4,15] and the modified Okada classification in six studies [10,11,13,14,16,17]. There was one study [12] that did not classify the procedures.…”