Outcomes and prognostic factors for sleeve lobectomy in patients with locally advanced non-small cell lung cancer.

PURPOSE: To evaluate the safety and efficacy of sleeve lobectomy for patients with non-small cell lung cancer (NSCLC) and assess the prognostic impact of preoperative chemoradiotherapy. METHODS: The subjects of this retrospective study were 103 consecutive patients who underwent sleeve lobectomy at our institution between 2006 and 2021. RESULTS: Sixty patients had squamous cell carcinoma (Sq), 33 had adenocarcinoma (Ad), and 10 had other types of NSCLC. Four anastomotic complications occurred, but there was no perioperative mortality. Downstaging was observed after preoperative treatment in 74% of 19 patients with Sq, and 56% of 9 patients with Ad. The pathologic response was greater in the patients with Sq than in those with Ad (- 91% vs. -32%). The 5-year overall survival (OS) and disease-free survival (DFS) rates were 62.3% and 58.1%, respectively. The patients with Sq had better DFS (73.5% vs. 21.6%) and OS (70.5% vs. 46.7%) than those with Ad. Multivariate analysis identified Ad histology (HR, 3.042; p = 0.0026) as a prognostic factor for DFS, and incomplete resection (HR, 2.940; p = 0.048) as a prognostic factor for OS. Among the 39 patients with recurrence, distant metastases were more frequent in those with Ad (72.7%) than in those with Sq (33.3%). CONCLUSION: Sleeve lobectomy is safe and effective for locally advanced NSCLC. Preoperative chemoradiotherapy was more effective for patients with locally advanced Sq than for those with Ad.

Duke Scholars

Author Hiroshi Date Surgery, Cardiovascular and Thoracic Surgery