Extended Sleeve Lobectomy Is An Alternative For Centrally Located Lung Cancer With Superior Short- And Long-Term Outcomes

The survival benefit of extended sleeve lobectomy (ESL) is unclear, and preoperative selection remains controversial. Twenty-three patients underwent ESL, and the 3-year overall survival and disease-free survival were comparable with pneumonectomy. Good pulmonary function was observed with ESL (forced expiratory volume in 1 second, 1.6 +/- 0.3 L, 1-year follow-up). We recommend ESL for centrally located lung cancer and suggest 3-dimensional reconstruction for ESL candidate selection. Introduction: Extended sleeve lobectomy (ESL) is a feasible alternative to pneumonectomy; however, the survival benefit is unclear, and preoperative selection of potential candidates for ESL remains a problem. Matierals and Methods: ESL was performed on selected candidates with double sleeve lobectomy for more than 1 lobe (eg, left upper lobe and S6 segment resection). Three-dimensional (3-D) reconstruction was routinely validated. Patients were candidates for ESL if the predicted distal stump length was > 6 mm and the pulmonary vein of the remaining segments was not invaded. Results: Of the 1809 patients with centrally located lung cancer for surgical resection, 86 patients with tumors invading more than 1 lobe were enrolled in the study. After evaluation by 3-D reconstruction, 22 (95.7%) of 23 selected candidates underwent ESL, and 63 patients were deemed unsuitable for ESL and underwent pneumonectomy (43 cases) or thoracic exploration (20 cases). Surgical outcomes between the ESL and pneumonectomy groups were similar in terms of complications, blood loss and surgical duration, but the 6-minute walking distance was significantly improved in the ESL group (371 +/- 111 m vs. 191 +/- 55 m, respectively; P < .001). The mean forced expiratory volume in 1 second was 1.6 +/- 0.3 L at the 1-year follow up examination in the ESL group. In the survival analysis, no difference was observed between the ESL and pneumonectomy groups in terms of 3-year overall survival (85% vs. 89%, respectively; P = .626) and 3-year disease-free survival (75% vs. 76%, respectively; P = .625). Conclusions: ESL is a feasible and superior surgical procedure in terms of its short-term and long-term outcomes, and we suggest 3-D reconstruction to identify candidates for ESL.