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J Thorac Cardiovasc Surg 2008;136:1349-1356
© 2008 The American Association for Thoracic Surgery

General Thoracic Surgery

Sleeve lung resection for lung cancer: Analysis according to the type of procedure

^a Department of Thoracic Surgery, National Hospital, Organization Himeji Medical Center, Himeji, Japan
^b Department of Thoracic Surgery, Tenri Hospital, Tenri, Japan
^c Faculty of Engineering, Tokyo University of Science, Tokyo, Japan

Received for publication November 5, 2007; revisions received February 23, 2008; accepted for publication May 4, 2008.

^_* Address for reprints: Kazumichi Yamamoto, MD, Department of Thoracic Surgery, National Hospital, Organization Himeji Medical Center, Honmachi 68, Himeji, Hyogo, 670-8520, Japan. (Email: granada{at}d3.dion.ne.jp).

Objective: Although sleeve lobectomy for lung cancer is widely accepted as an alternative to pneumonectomy, its use remains controversial. This study aimed to evaluate the surgical results after sleeve lung resection and to compare the outcomes of different procedural approaches.

Methods: The medical records of 201 patients who underwent sleeve lung resection for lung cancer were retrospectively reviewed. Three groups were compared: a standard group (lobectomy or bilobectomy; n = 173), limited group (segmentectomy; n = 8), and extended group (lobectomy or bilobectomy plus segmentectomy; n = 20).

Results: Three patients died postoperatively (1.4%). Anastomotic complications occurred in 7 patients (3.4%; fistula in 4 patients, stenosis in 3 patients), 6 of whom were successfully treated surgically or conservatively. Five-year overall and disease-free survivals were 57.8% and 50.3%, respectively. Sites of recurrence included anastomotic sites (n = 5), ipsilateral thorax (n = 11), mediastinum (n = 10), and distant sites (n = 43). Multivariate analysis showed that the influence of nodal status on both overall and disease-free survival was significant. All patients in the limited group but 1 who underwent lobectomy for recurrence in another lobe are alive without recurrence. Three patients in the extended group experienced distant metastasis, but none experienced local recurrences. Multivariate analysis showed extended group-to-standard group hazard ratios of 0.53 (95% confidence interval, 0.23–1.23) for overall survival and 0.48 (95 confidence interval, 0.22–1.05) for disease-free survival.

Conclusion: Sleeve lung resection can achieve local tumor control and long-term survival with low mortality and few anastomotic complications. Nodal status significantly affects long-term survival. Limited and extended resections are also feasible with local and long-term results comparable to those of standard sleeve lobectomy.

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