Local control of disease related to lymph node involvement in non-small cell lung cancer after sleeve lobectomy compared with pneumonectomy

Background. Increasing evidence has suggested that sleeve lobectomy might be a viable alternative procedure for pneumonectomy in non-small cell lung cancer (NSCLC), including patients with adequate pulmonary reserve. This study was designed to compare the outcomes of the two procedures and to determine adequate surgical indications for each procedure. Methods. From January of 1989 to December of 1998, sleeve lobectomy was performed in 49 patients, and 200 patients underwent pneumonectomy for NSCLC. By reviewing the computed tomographic scans, bronchoscopic findings, and operative reports, we selected 49 patients on whom sleeve resection could have been performed. The clinical outcomes of the sleeve lobectomies (SL) and pneumonectomies (PN) were analyzed, particularly in relation to nodal status and recurrence patterns. Results. Operative mortality was 6.1% (3 of 49 patients) in the SL group and 4.1% (2 of 49 patients) in the PN group. Mean follow-up period was 51 months (range, 5 to 149). The overall 5-year survival rate was not substantially different between the two groups (SL: 53.7% vs PN: 59.5%, p = 0.510). Recurrence occurred in 57% (26 of 46 patients) of the SL group and in 30% (14 of 47 patients) of the PN group. The 5-year freedom from recurrence rates were better in the PN group (SL: 45.7% vs PN: 67.9%, p = 0.017). Locoregional recurrences occurred in 32.6% (15 of 46 patients) of the SL group and in 8.5% (4 of 47 patients) of the PN group. In multivariate analysis, performing sleeve resection in patients with a positive N1 lymph node was a significant risk factor for developing locoregional recurrence (p = 0.007). Conclusions. Although the overall survival rates were similar, sleeve resection resulted in higher locoregional recurrence, particularly in patients with positive N1 lymph nodes. This finding suggests that sleeve resection should be performed in selected patients, such as those without lymph node metastasis.