Extended Sleeve Lobectomy for Locally Advanced Lung Cancer

Background: The risk of perioperative mortality is greater for patients undergoing a pneumonectomy than for a sleeve lobectomy. At our institution, we perform an extended sleeve lobectomy, an atypical sleeve resection of more than one lobe, to avoid a pneumonectomy in patients with locally advanced lung cancer. The purpose of this study was to analyze the risks of complications and local control in patients who underwent an extended sleeve lobectomy procedure. Methods: Patients who underwent an extended sleeve lobectomy procedure were retrospectively analyzed in regard to operative mortality, complications, and local recurrence. Results: A total of 23 patients underwent an extended sleeve lobectomy: one lobe + segment in 15, two lobes in 7, and two lobes + segment in 1. There were no operative deaths within 30 days or hospital deaths. Two (8.7%) of the 23 patients had complications at the anastomosis site, a stricture in 1 and bronchopleural fistula in 1, whereas 2 (8.7%) others had local control failure, relapse at the anastomosis site in 1 and staple line relapse in 1. Long-term survival was similar to that of those who underwent a pneumonectomy during the same period. Conclusions: Our extended sleeve lobectomy procedure is useful to avoid a pneumonectomy in patients with locally advanced lung cancer.