Extended Sleeve Lobectomy for Locally Advanced Lung Cancer

Extended Sleeve Lobectomy: One More Step Toward Avoiding Pneumonectomy in Centrally Located Lung Cancer

“…The absence of operative mortality in our study is comparable to that of other reports so far [6,7,8] and supports the use of ESL to replace pneumonectomy. The most frequent major complication management procedure was reoperation for completion pneumonectomy, and endoscopic treatment of anastomosis-related complications (Table 2).…”

“…Since the beginning of our experience, similar to Okada and coworkers [6], we have adapted the proximal bronchial stump diameter to match the distal one by inserting transverse stitches through the membranous portion. Both in our series and in the 3 previously reported ESL series, only telescoping [7,8] or modified end-to-end [6, current series] anastomoses were used, with slightly different complication rates, but the only reported transmural necrosis occurred when using the telescoping technique.…”

“…In sleeve resection series [6,7,8,[18][19][20], various bronchial anastomosis techniques have been reported to amend caliber and shape discrepancies, and changes in bronchial direction between the proximal and distal stumps. In cases of notable diameter mismatch, Hollaus and colleagues [18] applied a telescoping anastomosis technique (n ¼ 15), bringing the distal bronchus up into the lumen of the proximal stump.…”

“…When parenchymal sparing is technically feasible and R0 is possible but resection involving more than 1 lobe is required for oncologic or functional reasons (eg, tumors involving fissures or a section of the segmental pulmonary arteries of the remnant lobe, respectively), extended sleeve lobectomy (ESL) may represent a lastditch effort to avoid pneumonectomy. Three series of ESL have been reported so far, by Okada and associates [6], Chida and colleagues [7] and Yamamoto and coworkers [8], and have demonstrated feasibility. Here we describe our institutional experience with ESL in 27 patients with centrally located NSCLC and assess our surgical results in terms of lung function, postoperative complications, and long-term survival.…”

Extended sleeve lobectomy for interlobar lymph node metastasis invading the bronchus from peripheral lung cancer

“…1 This procedure is used as an alternative to pneumonectomy for the treatment of locally advanced lung cancer. 1,2 Although centrally located tumors without lymph node metastasis are the most suitable type of tumors for extended sleeve lobectomy, 1 the validity of this surgical procedure is controversial in patients with peripheral lung cancer with interlobar lymph node metastasis invading the bronchus in an extranodal manner. We applied extended sleeve lobectomy to the removal of interlobar lymph node metastasis infi ltrating into the bronchus.…”