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Original Articles: General Thoracic

Long-Term Results of Sleeve Lobectomy in the Management of Non–Small Cell Lung Carcinoma and Low-Grade Neoplasms

General Thoracic Surgery Division, Massachusetts General Hospital, and Department of Surgery, Harvard Medical School, Boston, Massachusetts

Accepted for publication July 28, 2009.

^_* Address correspondence to Dr Wright, Department of Thoracic Surgery, Massachusetts General Hospital, 32 Fruit St, Blake 1570, Boston, MA 02114 (Email: cdwright{at}partners.org).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: The objective of this study was to evaluate the operative mortality, morbidity, and long-term survival of sleeve lobectomy for non–small cell lung cancer and low-grade neoplasms. We evaluated the effects of neoadjuvant therapy on the bronchial anastomotic complication rate and determined whether sleeve lobectomy performed in patients with N1 disease resulted in decreased overall survival.

Methods: This study is a retrospective review of 196 patients who underwent sleeve lobectomy. One hundred twenty-five patients had non–small cell lung cancer. There were 117 men (59.7%) and 79 women (40.3%) with a mean age of 54 years. Sixteen patients (13%) received neoadjuvant therapy. Fifty-six patients with N1 disease underwent sleeve lobectomy.

Results: There were 4 (2.0%) postoperative deaths. The postoperative morbidity rate was 36.7%. Four patients (2.0%) experienced bronchopleural fistulas. Multivariate analysis demonstrated that age older than 70 years (p = 0.02) and the diagnosis of non–small cell lung cancer (p = 0.0002) were risk factors for postoperative complications. Multivariate analysis also demonstrated that neoadjuvant therapy predicted anastomotic complications (p = 0.01). For non–small cell lung cancer patients, the 5-year survival rate was 44%. The 5-year survival rates for patients with pathologic N0 disease and N1 disease were 52.6% versus 39.3%, respectively (p = 0.205).

Conclusions: Sleeve lobectomy can be performed with minimal bronchial anastomotic complications and low postoperative mortality. In our study, neoadjuvant therapy for non–small cell lung cancer adversely influenced the rate of anastomotic complications. Performing sleeve lobectomy for patients with N1 disease was not associated with decreased overall survival rates.

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