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

Abstract

Objective: We conducted a thorough literature search on patients with central non-small cell lung cancer (NSCLC) undergoing either extended sleeve lobectomy (ESL) or pneumonectomy (PN). Methods: We identified all original research studies that compared the long-term survival of ESL versus PN from 1990 to 2022. The primary endpoints were the median overall survival (OS) and disease-free survival (DFS). Complications, operative mortality, and the reoperation rate were the secondary endpoints. Regarding the primary endpoints, independent patient data were extracted from the included studies, and pooled Kaplan–Meier curves were constructed. A sensitivity analysis was performed using the leave-one-out method. Results: Nine studies were included in the qualitative and seven in the quantitative synthesis, including 431 patients. Patients in the ESL group demonstrated a significantly higher OS compared with the PN group (HR, 0.63; 95% CI, 0.46–0.87; p = 0.005). In addition, patients undergoing ESL presented a significantly higher DFS compared to the PN group (HR, 0.57; 95% CI, 0.40–0.80; p = 0.004). These findings were further validated with a sensitivity analysis. The most common complications in the ESL group were bronchopleural fistula (4.6%), stricture (3.1%), prolonged air leakage (7.3%), sputum retention (4.6%), pneumonia (7.7%), and pulmonary vein thrombosis (1.5%). ESL was associated with a low reoperation rate (1.5%) and operative mortality (1.2%). Conclusions: The present meta-analysis indicates that ESL is associated with enhanced survival outcomes compared to PN for patients with central NSCLC. Further randomized controlled trials are necessary to validate our findings.

Complex Sleeve Lobectomy Has Lower Postoperative Major Complications Than Pneumonectomy in Patients with Centrally Located Non-Small-Cell Lung Cancer

“…In the group of CSL patients, the majority of patients who experienced complications suffered from prolonged air leak, bronchial obstruction requiring bronchoscopy, atrial fibrillation and anemia with blood transfusion; these adverse events are not life-threatening and can be easily managed, although they may result in prolonged hospital stays. Regarding the technical complexity of CSL and the resulting potentially fatal complications associated with bronchial and/or vascular reconstruction, there are controversial findings in the literature [23]. Okada et al [12] were the first who reported the postoperative clinical and oncological results of n = 15 ESL patients at the end of the 1990s, showing no postoperative death, acceptable complications, no incidence of broncho-pleural fistula or anastomotic stenosis and complete resection achieved in all patients.…”

“…Okada et al [12] were the first who reported the postoperative clinical and oncological results of n = 15 ESL patients at the end of the 1990s, showing no postoperative death, acceptable complications, no incidence of broncho-pleural fistula or anastomotic stenosis and complete resection achieved in all patients. Others [14][15][16]23] reported a low mortality rate (0-3%), acceptable overall and anastomotic complications (3-8.7%), a high rate of complete resection and long-term oncological outcomes comparable to those of the control group, which consisted of patients undergoing PN [14] or SSL [16]. Conversely, two other recent papers [16,17] reported four and two cases of completion of PN due to venous thrombosis (n = 2), arterial thrombosis (n = 1) or bronchopleural fistula (n = 3), respectively.…”

Progression-Free and Overall Survival of First-Line Treatments for Advanced Renal Cell Carcinoma: Indirect Comparison of Six Combination Regimens

“…In recent years, the Shiny method has increasingly been used not only in oncology but also in other areas of of therapeutics, such as medical devices [ 20 ], surgery [ 21 , 22 ] and also in patients with COVID-19 [ 23 ]. However, oncology and oncohematology remain the two main areas of application, where the Shiny method represents a quite simple alternative to network meta-analysis [ 8 , 9 , 24 , 25 ].…”

Preoperative Evaluation Management of the Patient with Endobronchial Tumor – Our Experience

“…Pure endobronchial neoplasms are a rare entity, and they can present various pathologies [2]. The evaluation of patients with suspected endobronchial lung cancer includes a diagnosis of the primary tumor, an assessment of the extent of spread to regional or distant lymph nodes, or to other structures [3], Preoperative Assessment Prior to Lung Resection [4] and the Thoracic Revised Cardiac Risk Index (ThRCRI) [5]. Lung tumors located centrally, endobronchial, most often have an indication Disclaimer/Publisher's Note: The statements, opinions, and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s).…”