A quarter of a century experience with sleeve lobectomy for non-small cell lung cancer

OBJECTIVE: Sleeve lobectomy represents an effective and widely accepted surgical therapy for non-small cell lung carcinoma (NSCLC). We sought to review our experience in terms of mortality, early and late morbidity, and long-term survival evaluating the technical progresses overtime. MATERIAL AND METHODS: From 1980 to 2005, 199 patients underwent sleeve lobectomy. Pathology revealed 167 (83.9%) squamous carcinomas, 23 (11.6%) adenocarcinomas, 7 (3.5%) large cell and 2 (1%) adenosquamous carcinomas. In 39 (19.6%) patients a vascular procedure was associated. Nineteen (9.5%) patients had preoperative radiotherapy, 14 (7%) preoperative chemotherapy and 10 (5%) chemoradiotherapy. RESULTS: Overall postoperative mortality was 4.5% (n=9) and morbidity was 17.9% (n=34). Preoperative radiotherapy was identified as a significant risk factor for perioperative mortality (OR: 5.34, 95% CI: 1.16-24.47; p=0.03) and early anastomotic complications (OR: 3.73, 95% CI: 1.01-13.68; p=0.04). Overall 5-year survival rate was 39.7% and stage-by-stage analysis did not reach a significant survival difference. With growing skills the number of procedures, associated angioplasty and difficult sleeves (such as sleeve bilobectomy) increased. Also in term of mortality, in the last 10 years we had 0.8% of mortality rate. CONCLUSIONS: Sleeve lobectomy is a safe and effective therapy for selected patients with NSCLC. Vascular procedures and the use of induction chemotherapy did not increase mortality and morbidity; otherwise, the use of preoperative radiotherapy is not recommended. Overtime trend showed a significant lower mortality in the last period. This emphasises the importance of a learning curve and encourages the performance of this procedure in experienced centres.