Reply

Abstract

We thank Dr Deng for his comments1Deng H.-Y. Sleeve lobectomy for centrally located non-small cell lung cancer: does incision size really matter? (letter).Ann Thorac Surg. 2020; 109: 612Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar on our article.2Gao H.-J. Jiang Z.-H. Gong L. et al.Video-assisted vs thoracotomy sleeve lobectomy for lung cancer: a propensity matched analysis.Ann Thorac Surg. 2019; 108: 1072-1079Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar For patients with non-small-cell lung cancer (NSCLC) who are undergoing surgery, the complete resection of the tumor and the safety of the procedure are the focus to thoracic surgeons. The improvement of R0 resection can fundamentally ameliorate quality of life and survival outcomes. Even the current extensive research on tumor-related induction therapy is essentially aimed at improving the R0 resection rate of operation. For some centrally located NSCLCs, sleeve lobectomy not only prevents the risk of residual tumor due to anatomical lobectomy, but also prevents a significantly reduced quality of life after pneumonectomy.3Ludwig C. Stoelben E. Olschewski M. et al.Comparison of morbidity, 30-day mortality, and long-term survival after pneumonectomy and sleeve lobectomy for non-small cell lung carcinoma.Ann Thorac Surg. 2005; 79: 968-973Abstract Full Text Full Text PDF PubMed Scopus (156) Google Scholar,4Ma Z. Dong A. Fan J. et al.Does sleeve lobectomy concomitant with or without pulmonary artery reconstruction (double sleeve) have favorable results for non-small cell lung cancer compared with pneumonectomy? A meta-analysis.Eur J Cardiothorac Surg. 2007; 32: 20-28Crossref PubMed Scopus (123) Google Scholar In addition, the development of sleeve lobectomy has enabled patients who have previously been unable to tolerate pneumonectomy to have a chance for R0 resection. Although there is no significant benefit to disease-free survival and overall survival, video-assisted thoracoscopic surgery (VATS) has been shown to improve perioperative outcomes in patients with NSCLC. With increasing experience in VATS lobectomy and proficiency in endoscopic suturing and tying techniques, some experienced centers have attempted to perform more complex VATS, including sleeve lobectomy. In our study, VATS sleeve lobectomy provides better postoperative recovery, with less blood loss, shorter thoracic drainage stay, and less postoperative hospital stay than for an open procedure, even after PSM.2Gao H.-J. Jiang Z.-H. Gong L. et al.Video-assisted vs thoracotomy sleeve lobectomy for lung cancer: a propensity matched analysis.Ann Thorac Surg. 2019; 108: 1072-1079Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar However, regardless of the surgical approach and the development of medical devices, the oncologic results and surgical safety should always be the primary concern of thoracic surgeons. For experienced and conditional medical centers, VATS sleeve surgery can be performed gradually. In fact, skilled and experienced surgeons performing minimally invasive surgery can indeed improve perioperative outcomes. However, the surgeon should not be restricted by the specific surgical procedure. Under the premise of ensuring the quality of the operation, the status of the disease is the key factor in our choice of surgical procedure. Sleeve Lobectomy for Centrally Located Non-Small Cell Lung Cancer: Does Incision Size Really Matter?The Annals of Thoracic SurgeryVol. 109Issue 2PreviewSleeve lobectomy (SL) has become the preferred option for centrally located non-small cell lung cancer (NSCLC) because of the advantages of lung-sparing and potentially superior survival to pneumonectomy.1 However, SL is still challenging with complicated procedures, especially under video-assisted thoracoscopic surgery (VATS). The study by Gao and colleagues2 compared the effects of VATS SL and thoracotomy SL in treating centrally located NSCLC by including 148 patients. In the unmatched patients, they found that VATS SL yielded significantly better survival than thoracotomy SL did. Full-Text PDF