Lung sparing surgery by means of extended broncho-angioplastic (sleeve) lobectomies

• Published in: Archivos de bronconeumología (English ed.) 2011-01, Vol.47 (2), p.66-72
• Main Authors: Gómez-Caro, Abel, García, Samuel, José Jiménez, María, Matute, Purificación, Gimferrer, J.M, Molins, Laureano
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Bronchi; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - surgery; Complicaciones; Complications; Cáncer de pulmón; Female; Humans; Internal Medicine; Lung cancer; Lung Neoplasms - mortality; Lung Neoplasms - surgery; Lung Preservation; Male; Middle Aged; Pneumonectomy - adverse effects; Pneumonectomy - methods; Pneumonectomy - mortality; Postoperative Complications - epidemiology; Preservación pulmonar; Pulmonary/Respiratory; Sleeve lobectomy; Survival Rate
• ISSN: 1579-2129; 1579-2129
• DOI: 10.1016/S1579-2129(11)70016-7

Abstract Objective To determine the morbidity, mortality and survival of sleeve lobectomy procedures extended to more than one lobe compared with bronchoplasty. Patients and methods Between September 2005 and May 2010, a total of 535 patients diagnosed with bronchogenic carcinoma who fulfilled the criteria of clinical, oncological and functional operability were treated in our unit. Central tumors ( n = 95) that were unresectable using simple lobectomy were scheduled for sleeve lobectomy techniques or, if not possible, pneumonectomy. Results A total of 58 (11%) procedures were performed: 46 simple bronchoplastic lobectomies (SBL) and 12 extended sleeve lobectomies (ESL). In the SBL group, there were 32 bronchial (70%), 7 vascular (15%) and 7 bronchovascular (15%) reconstructions. In the ESL group, 8 (66.7%) were bronchial and 4 (33.3%) were bronchovascular reconstructions. The most frequent type of resection was the right upper lobe (RUL) + segment 6 in five (41%) cases, followed by RUL + middle lobe. There were 2 (3%) deaths in the SBL group. Morbidity was 34% in the SBL and 33% in the ESL group ( P > 0.05). Fifteen patients received neoadjuvant chemoradiotherapy for histologically-confirmed cN2; the number of complications, however, was not significantly higher. No risk factors were detected in any variable studied that would affect ESL compared to the SBL group ( P > 0.05). The patients in both groups with a higher morbidity were pN1, located in the left upper lobe and associated with vascular reconstruction ( P < 0.05). The overall five-year survival was 61.6%; SBL (61%) and ESL (68.9%) with no differences between groups ( P > 0.05). Conclusions ESL are technically more demanding procedures, but they do not increase morbidity or mortality compared to simple bronchoplasty, and have similar survival.