Comparison of morbidity, 30-day mortality and long-term survival after pneumonectomy and sleeve lobectomy for NSCLC

Objective: The aim of this retrospective, non-randomized study was to compare early and late outcome of these procedures. The equivalence of the radicality in resection of non-small cell lung cancer has been questioned for sleeve lobectomy. However, most reports show a higher operative risk for pneumonectomy. Method: The charts of 310 patients who underwent either pneumonectomy or sleeve lobectomy for lung cancer stage I to stage IIIa from 1987-1997 were reviewed. A total of 194 patients underwent pneumonectomy and 116 patients underwent sleeve lobectomy. Specific operative complications, i.e. anastomotic leakage versus stump dehiscence, perioperative complications, and 30-day- or in-hospital mortality were registered for comparison of the immediate risk of the respective procedures. The 5-year follow-up is complete in 291 patients (96%). The follow-up data were analyzed for the comparison of oncologic adequacy. Results: In the group of bronchial sleeve lobectomy (SL) the incidence of anastomotic leakage was 6.9% (8/116) and the operative mortality was 4.3%. The incidence of bronchial stump fistula after pneumonectomy was 3.6% (7/194), and the early mortality was 4.6%. All but 6 patients (98%) had complete resection. The 5-year survival after sleeve lobectomy was 39% and after pneumonectomy 27%. Multivariate analysis of the data demonstrated that age <65, sleeve lobectomy, pNO and stage I are prognostically favorable factors. Conclusion: The indication for pneumonectomy vs. sleeve lobectomy depends on the localization of the primary tumor which is usually more advanced in the pneumonectomy group, on the one hand, and on cardio-respiratory function which is often distinctly impaired in the sleeve group, on the other hand. This might explain why the mortality in the group of sleeve lobectomy was identical with that in the pneumonectomy group. However, it is shown that both techniques are appropriate modalities of treatment in the case of more advanced cancer and/or critical functional reserve, respectively.