Comparison of Bronchial Sleeve Lobectomy With Pulmonary Arterioplasty Versus Pneumonectomy

Abstract

BackgroundThis study evaluated the efficacy of bronchial sleeve lobectomy with pulmonary arterioplasty compared with pneumonectomy in centrally located non-small cell lung cancer with bronchovascular invasion. MethodsThe cohort consisted of 212 patients receiving pneumonectomy and 156 patients undergoing bronchial sleeve lobectomy with pulmonary arterioplasty. Propensity score matching was used to create a fully balanced cohort, after which, baseline characteristics, perioperative performance, and oncologic results were compared between the 2 groups. ResultsA total of 139 pneumonectomy patients were matched with 139 sleeve lobectomy patients. In the matched cohort, bronchial sleeve lobectomy with pulmonary arterioplasty was associated with longer operative time (P < .001), decreased perioperative transfusion rate (P = .002), shorter postoperative hospital stays (P < .001), shorter intensive care unit stays (P = .040), and lower Clavien-Dindo Classification (P = .016). In respect to survival outcomes, a log-rank test revealed no significant difference in overall survival (P = .381) and recurrence-free survival (P = .619) between the 2 surgical procedures. ConclusionsBronchial sleeve lobectomy with pulmonary arterioplasty could achieve superior perioperative outcomes and equivalent oncologic efficacy compared with pneumonectomy, indicating that this complex procedure is safe and reliable for centrally located non-small cell lung cancer concurrently involving the pulmonary artery and bronchus.