Sleeve Lobectomy Compared with Pneumonectomy after Induction Therapy for Non–Small-Cell Lung Cancer

• DOI: 10.1097/jto.0b013e318286d145
• Publication Date: 2013-04-11T21:17:30Z
• Authors: Giulio Maurizi; Antonio D'Andrilli; Marco Anile; Anna Maria Ciccone; Mohsen Ibrahim; Federico Venuta; Erino Angelo Rendina
• Keywords: Pulmonary and Respiratory Medicine; Adult; Male; Lung Neoplasms; Paclitaxel; Kaplan-Meier Estimate; Induction therapy; Deoxycytidine; Carboplatin; 03 medical and health sciences; 0302 clinical medicine; Carcinoma, Non-Small-Cell Lung; Antineoplastic Combined Chemotherapy Protocols; Humans; Pneumonectomy; Aged; Neoplasm Staging; Sleeve lobectomy; Non–small-cell lung cancer; Induction Chemotherapy; Middle Aged; Neoadjuvant Therapy; 3. Good health; Oncology; Chemotherapy, Adjuvant; Multivariate Analysis; Female; Cisplatin

We compared morbidity, mortality, and oncological results of bronchial and/or vascular sleeve lobectomy (SL) with those of pneumonectomy (PN) after induction therapy for lung cancer.Between 1998 and 2011, 82 patients receiving induction therapy (chemo or chemo-radiotherapy) for non-small-cell-lung-cancer underwent sleeve lobectomy (n = 39) or pneumonectomy (n= 43). Only patients undergoing preoperative chemotherapy (39 in the SL group and 39 in the PN group) were included in the study. SL was bronchial in 21, vascular in 12, and broncho-vascular in six cases, respectively. Clinical stage before induction therapy was IIb in seven patients (1 in PN group; 6 in SL group), IIIa in 66 (36 in PN group; 30 in SL group), and IIIb in five patients (2 in PN group; 3 in SL group), respectively. N3 patients were not included in this series.The rate of downstaged patients (pathological complete response and stage I-II) was 79.5% in the SL group and 53.8% in the PN group (p = 0.01).Postpneumonectomy mortality rate was 2.6 %. There was no postoperative mortality after SL. Complications occurred in 12 patients (30.8%) after PN and in 11 patients (28.2%) after SL (p = 0.6). Three-year and 5-year survival rates were 68 ± 3% and 64 ± 8% in the SL group; and 59.5 ± 5% and 34.5 ± 8% in the PN group (p = 0.02). The difference in terms of recurrence rate (locoregional and distant) between the two groups was not significant (p = 0.2).SL represents a valid therapeutic option even after induction chemotherapy, providing better long-term survival than PN, with no increase of postoperative complications or recurrence rate. Pathological downstaging is a favorable prognostic factor.