Lung Cancer

For patients with a nonsmall cell carcinoma surviving resection, long-term survival appears to be related to the disease stage but not to the type of resection. In retrospective comparisons adjusted for stage, there is no important difference in survival between sleeve lobectomy and pneumonectomy. In a paired comparison between the two procedures, by nearest available matching of patients, Okada and colleagues found significantly longer survival at 3-, 5-, and 10-year intervals after sleeve lobectomy, with no difference in local recurrence.17 They pursue bronchoplastic procedures aggressively and advocate extended sleeve resections to avoid pneumonectomy.40 Their comparison, although carefully performed, points to a weakness of any retrospective attempt to demonstrate superior results of sleeve lobectomy. In favoring sleeve resection, their pool of pneumonectomy patients contains fewer and presumably more advanced tumors.

Following sleeve lobectomy, surgical resection results in 5-year survival of 36 to 79% in stage I, and 23 to 55% in stage II (Table 16-5).41 In the MGH series, a few patients had chest wall involvement.15 However, because T3 or T4 tumors are rarely treated with bronchial sleeve resection (as opposed to carinal resection), some authors distinguish between N0 and N1 disease, with comparable results, as noted in Table 16-5. The numbers for patients with stage IIIA or N2 disease are too small to draw conclusions about the value of sleeve resection or the effectiveness of adjuvant therapy. The MGH series showed no difference in survival at 5 years between 48 patients undergoing upper lobectomy (46 ± 8.5%) and in 13 patients after middle and lower lobectomy (52 ± 14%).

Okada and colleagues performed extended resections in 15 of 157 patients undergoing sleeve lobectomy, ranging from resection of the upper lobe and superior segment to resection of the lower lobe and lin-gula (Figure 16-5).40 Eight of their 15 patients underwent an arterial resection. After 12 to 106 months, all the patients with stage IIB disease and half of the patients with stage IIIA disease were alive without recurrence, although the other half of stage IIIA patients died of distant metastases within 1 year. The reimplanted lung contributed 26 ± 18% of overall function.

Table 16-5 Late Results and Local Recurrence after Sleeve Lobectomy for Lung Cancer

First Author, Year

% Patients undergoing Mediastinoscopy

Overall 5-Year Survival (%)

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