Sleeve, Semi-sleeve Lobectomy, Segment Pyramidobasalectomy in Patients with Preoperative Contraindications for Pneumonectomy

Abstract

Background: Sleeve and semisleeve lobectomy and segment pyramydobasalectomy is a parenchyma-sparing procedure that is particularly valuable in patients with cardiac or pulmonary contraindications to pneumonectomy. The purpose of this study is to report our experience with sleeve lobectomy for bronchogenic cancer and carcinoid , and to investigate factors associated with long-term survival. Methods: Retrospective descriptive study among January 2006 to November 2014,in the Service of Thoracic Surgery in the University Hospital”Shefqet Ndroqi” in patients treated for lung cancer. Results: Patients underwent sleeve lobectomy for non-small-cell lung cancer (n = 3) one patient underwent double sleeve lobectomy or carcinoid tumor (n = 15), including 5 patients underwent sleeve lobectomy (atipic carcinoid) and 10 patients underwent semisleeve lobectomy (tipic carcinoid) with a preoperative contraindication to pneumonectomy. Mean age was 52 ± 14 years (range, 19 to 79 years). Vascular sleeve resection was performed in 1 patient and segmentbasalectomy on the right lung. Major bronchial anastomotic complications occurred in 2 (13%) patient: One was fatal postoperatively (double sleeve bronchial and vasculare) two weeks after intervent ,because was massive hemoptisia , and one after pyramidbazalectomy 6-th day after intervent, because nosocomial difusse pneumonia in the rest lung (shock septic) was installed. In the non-small-cell lung cancer group, operative mortality was 13% (2 of 15), and overall 5-year and 10-year survival rates were 60% . By multivariate analysis, two factors significantly and independently influenced survival: nodal status (N0 or N1 versus N2; p = 0.01) and microscopic invasion of the bronchial stump (p = 0.02). In the carcinoid tumor group, there were no operative deaths, and overall 5-year and 10-year survival rates were 100% (Typic carcinoid) and 95% (atipic carcinoid). Conclusions: Sleeve lobectomy was performed for the first time in Albania, in April 2006. Long-term survival is excellent for carcinoid tumors. For patients with non-small-cell lung cancer, N2 disease or incomplete resection is associated with a worse prognosis; outcome is not affected by presence of a preoperative contraindication to pneumonectomy.Sleeve lobectomy facilitated the maintenance of residual lung function without serious perioperative complications.