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The Journal of Thoracic and Cardiovascular Surgery, Vol 92, 871-879, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
J Deslauriers, P Gaulin, M Beaulieu, M Piraux, R Bernier and Y Cormier
Sleeve lobectomy is a lung-saving operation in which a portion of main
bronchus is removed in continuity with the involved lobe to preserve distal
parenchyma. Current controversies relate to indication and safety of the
procedure, adequacy as a cancer operation, and contribution of the
reimplanted lobe to overall remaining lung function. Between 1975 and 1985,
sleeve lobectomy was done electively in 72 patients with lung cancer. There
were no operative deaths, but major complications occurred in 10% of
patients. Most resected carcinomas were squamous (65/72). Complete
resection was performed in all but five patients. A minimum of 1 year's
follow-up information was available for all patients. For patients with N0
disease (n = 34) the cumulative 5 year survival rate was 67%, and for
patients with N1 status (n = 34) it was 60%. Although postoperative
pulmonary function studies at 5 years (n = 19) show subnormal values, they
were not severely altered with regard to percent of predicted (forced vital
capacity, 85.9% +/- 17.5%; forced expiratory volume in 1 second, 74.9% +/-
19.4%). Regional function was determined by ventilation/perfusion isotope
scanning methods. For 15 patients with right lung bronchoplasties,
perfusion ratios were 41.1% right lung/58.9% left lung. For four patients
with left sleeve operations, these ratios were 29.3% left lung/51.7% right
lung. Washout curves show comparable ventilation between the reimplanted
lobe and the contralateral lung. The data show that sleeve lobectomy is a
safe and adequate operation for patients with resectable lung cancer. The
reimplanted lobe or lobes contribute significantly to the overall remaining
lung function.
ARTICLES
Long-term clinical and functional results of sleeve lobectomy for primary lung cancer
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