Sleeve Lobectomy as an Alternative Procedure to Pneumonectomy for Non-small Cell Lung Cancer

Introduction: The aim of this study is to compare the outcomes of sleeve lobectomy (SL) and pneumonectomy (PN) and to determine which one is more acceptable standard procedure for patients with non-small cell lung cancer. Methods: From 1996 to 2005, 424 patients underwent SL (n = 157) and PN (n = 267) in our institution. Propensity score matching analysis was performed to compare these two groups for mortality, morbidity, survival, recurrence, and postoperative pulmonary function. Results: In each group, 105 patients were eligible for analysis. The operative mortality was lower in the SL group (1.0%) than the PN group (8.6%), (p < 0.0001). The morbidity was similar (33.4% versus 29.5%, p = 0.376). The 5-year survival was lower in the PN group (PN, 32.14% versus SL, 58.43%, p = 0.0002). The recurrence pattern (locoregional versus distant) did not differ between two groups (p = 0.180). The mean actual postoperative first second forced expiratory volume in the patients underwent SL was 2.05 +/- 0.55 liter, which increased by 7.9% compared with the predicted-postoperative first second forced expiratory volume. Conclusions: Our results showed that the SL can be performed with low operative risk and may offer superior survival and better postoperative pulmonary function compared with the PN in selected patients. If anatomically feasible, a SL must be considered as a favorable alternative to PN in patients with non-small cell lung cancer.