Sleeve Lobectomy Research Articles

Bronchus Anastomosis Healing Depending on Type of Neoadjuvant Therapy

Preoperative radiotherapy and/or chemotherapy of lung cancer in patients with locally advanced disease is an option in multimodal treatment. Sleeve lobectomy has an important part in decreasing complications and sparing lung function. We present our experience in a large cohort of patients after sleeve lobectomy with or without neoadjuvant treatment and standardized assessment of bronchial anastomotic healing. The data used for this study were collected ina prospective database in our hospital. Anastomotic healing was documented by bronchoscopy on the seventh postoperative day and thereafter only when necessary, using a standardized scoring system. From 2006 to 2017, we performed 501 sleeve lobectomies representing 19%of all lung cancer resections. A total of 365 ofpatients had no preoperative treatment (73%), 41 had neoadjuvant chemotherapy (8%), and 95 had radiochemotherapy (19%). Using our scoring system of the bronchial anastomosis from 1 (excellent) to 5 (insufficient), we found the anastomosis was worse than grade 2 after no treatment, chemotherapy, or radiochemotherapy in 17%, 10%, and 30%, respectively (P= .002). The rate of anastomotic insufficiency was equally low after no pretreatment and chemotherapy (2.7% and 2.4%) and rose to 10.4% after radiotherapy (P= .002). Similarly, the risk for pulmonary complications was higher after radiochemotherapy (39%) compared with no pretreatment (29%) or chemotherapy (27%), respectively (P= .382). Neoadjuvant radiotherapy is associated with worse wound healing of the anastomosis after sleeve lobectomy in lung cancer. There seems to be a higher risk for anastomotic insufficiency and complications.

Sleeve lobectomy compared with pneumonectomy for operable centrally located non-small cell lung cancer: a meta-analysis.

The purpose of this meta-analysis was to evaluate evidence comparing sleeve lobectomy (SL) and pneumonectomy (PN) in the treatment of non-small cell lung cancer (NSCLC). The English literature search was undertaken in January 2018 and included studies dating back to 1996. Comparative studies were identified, evaluating survival, local recurrence, and distant recurrence rates, operative mortality, 30-day mortality, as well as complications. A pooled odds ratio (OR) and 95% confidence intervals (95% CI) were calculated with either the random or fixed-effect model. A total of 27 studies were identified, with publication dates between 1996 and 2018. These 27 studies included a total of 14,194 patients: 4,145 treated with SL and 10,049 treated with PN. The overall survival was significantly higher in the SL group compared to the PN one at 1, 3, 5 years. In patients with N0 and N1 disease, 5-year survival rates following SL exceeded those following PN. There was no statistically significant difference in the 3-, 5-year overall survival of N2 patients, according to the extent of surgery. The PN group had a higher rate of operative mortality, 30-day mortality and distant recurrence incidence. However, no statistical difference in complications and local recurrence between SL and PN were observed. SL is an effective treatment option for hilar NSCLC with improved long-term survival compared to PN, with no increase of recurrence rate or postoperative complications. Furthermore, N2 disease is an important factor related to survival, and lymph node downstaging is a favorable prognostic factor.

Comparison of Double Sleeve Lobectomy by Uniportal Video-Assisted Thoracic Surgery (VATS) and Thoracotomy for NSCLC Treatment.

BackgroundWith the development of the surgical technique and experience of surgeons, uniportal VATS has been used in double sleeve lobectomy to treat non-small cell lung cancer (NSCLC). This retrospective study aims to evaluate the efficacy and safety of uniportal VATS in NSCLC treatment.MethodsWe reviewed 42 NSCLC patients who underwent double sleeve lobectomy in Shanghai Pulmonary Hospital from June 2015 to November 2017. 21 patients received double sleeve lobectomy through uniportal VATS and 21 through conventional thoracotomy with large incision.ResultsThe characteristics of patients were similar between the two groups. The operation time was longer in the uniportal VATS group (p=0.021) and the drainage on postoperation day 1 was significantly less in the uniportal VATS group (p=0.004). Patients reported a lower postoperative pain level in the uniportal VATS group than in the thoracotomy group (p=0.002). No statistically significant difference showed in other aspects.ConclusionUniportal VATS double sleeve lobectomy for NSCLC treatment is safe and effective. Lower postoperative pain level was found in the uniportal VATS group. Its complication rate and postoperation survival were similar to the conventional thoracotomy approach with large incision. But a large randomized clinical trial is still necessary for further investigation.

Robotic sleeve lobectomy for centrally located non–small cell lung cancer: A propensity score–weighted comparison with thoracoscopic and open surgery

ObjectiveTo evaluate the surgical and oncologic outcomes of robotic sleeve lobectomy in comparison with video-assisted thoracoscopic surgery (VATS) and open surgery. MethodsSurgical outcomes in patients with non–small cell lung cancer who underwent sleeve lobectomy via robotic, VATS, and thoracotomy were assessed using the χ2 test, Fisher exact test, and the Kruskal–Wallis rank sum test. Log-rank test and Cox proportional hazards model were used in survival analyses. Propensity score–weighted matching was used to achieve the balance of baseline among the 3 groups. ResultsBetween 2012 and 2017, 188 patients were included and divided into robotic (n = 49), VATS (n = 73), and open (n = 66) groups. After weighted matching that retained all patients, no statistical difference in 90-day mortality or morbidity among the 3 groups was shown. Patients in the robotic group had less bleeding loss (P < .001), operative time (P < .001), and tube drainage time (P < .001) than the other 2 groups. No positive bronchial margin or conversion presented in the robotic group. In multivariable analyses, surgical technique was independently associated with neither overall survival nor disease-free survival (P > .050). ConclusionsRobotic sleeve lobectomy is a safe, feasible, and effective procedure. Compared with VATS and open techniques, robotic sleeve lobectomy has a similar oncologic prognosis for patients with centrally located non–small cell lung cancer. Further studies with a larger sample size and long-term follow-up are needed.

Complete Uniportal Thoracoscopic Anatomic Lung Resection With Systematic Mediastinal Lymphadenectomy for Non-Small Cell Lung Cancer: Personal Experience of 326 Cases.

With its growing popularity and potential outcome, complete uniportal thoracoscopic (CUT) surgery has been used in the treatment of thoracic diseases. This study aimed to summarize a personal experience of CUT anatomic lung resection with systematic mediastinal lymphadenectomy (CUT-ALR-SML) for non-small cell lung cancer (NSCLC) and to evaluate the feasibility and safety of CUT-ALR-SML in our institute. A total of 326 patients with NSCLC were chosen to undergo CUT-ALR-SML in our institute from August 2013 to July 2018. Data such as clinicopathologic characteristics and perioperative outcomes were reviewed in this article. For the 326 cases of ALR, the specific procedures and the corresponding number of cases were as follows: segmentectomy, 90; lobectomy, 218; sleeve lobectomy, 9; ipsilateral lobe combined with segment resected synchronously (i-L+S), 6; and pneumonectomy, 3. A total of 31 cases required conversion to open surgery, and 4 cases were converted to multiportal thoracoscopic surgery. All patients underwent SML. The average mediastinal lymph node stations and mediastinal lymph nodes dissected under CUT-ALR-SML were 3.3±1.4 and 9.6±8.4, respectively. Approximately 99.7% of the patients acquired free resection margins. A total of 42 (12.9%) patients suffered from postoperative complications, and 1 patient died of pneumonia during the perioperative period. Complete uniportal ALR, particularly for segmentectomy and lobectomy is safe and feasible with low complication rates and excellent free resection margin rates. SML during complete uniportal thoracoscopic surgery adequately assesses the N2 lymph node. However, further studies need to be conducted to evaluate the role of CUT-ALR-SML in the treatment of NSCLC.

Left middle and lower sleeve lobectomy for lung cancer in a patient with complete situs inversus

Left middle and lower sleeve lobectomy for lung cancer in a patient with complete situs inversus

Expert consensus on tubeless video-assisted thoracoscopic surgery (Guangzhou).

With the development of minimally invasive thoracoscopic and anesthesia control techniques, intravenous anesthesia with spontaneous ventilation video-assisted thoracic surgery (SV-VATS) has been increasingly employed in management of pleural effusion, bullectomy for pneumothorax, mediastinal biopsy, thymectomy and thymomectomy, wedge lung resections, anatomical lung resections for radical treatment of lung cancer and even more complex surgical procedures including tracheal resection and sleeve lobectomy (1-7) This changes in surgical strategies have been applied in the believe that SV-VATS can avoid adverse effects of mechanical ventilation and the residual effects of muscle relaxants, can achieve a faster recovery of respiratory muscle function and lower operative morbidity (7,8).

EP1.18-20 Sleeve Lobectomy for Centrally Located Non-Small Cell Lung Cancer: Initial Short-Term Results from a Single Institute in Northeast China

EP1.18-20 Sleeve Lobectomy for Centrally Located Non-Small Cell Lung Cancer: Initial Short-Term Results from a Single Institute in Northeast China

Pneumonectomy for Lung Cancer Treatment in The Netherlands: Between-Hospital Variation and Outcomes

BackgroundPneumonectomy in lung cancer treatment is associated with considerable morbidity and mortality. Its use is reserved only for patients in whom a complete oncological resection by (sleeve) lobectomy is not possible. It is unclear whether a patients’ risk of receiving a pneumonectomy is equally distributed. This study examined between-hospital variation of pneumonectomy use for primary lung cancer in the Netherlands.MethodsData from the Dutch Lung Cancer Audit for Surgery from 2012 to 2016 were used to study the use of pneumonectomy for primary lung cancer in the Netherlands. Using multivariable logistic regression, factors associated with pneumonectomy use were identified and the expected number of pneumonectomies per hospital was determined. Subsequently, the observed/expected ratio (O/E ratio) per hospital was calculated to study between-hospital differences.ResultsOf the 8446 included patients, 659 (7.8%) underwent a pneumonectomy with a mean postoperative mortality of 7.1% (n = 47). Factors associated with receiving a pneumonectomy were age, gender, cardiac and pulmonary comorbidities, tumor side, size and histopathology. The pneumonectomy use in the Netherlands varied considerably between hospitals (IQR 5.5–10.1%). Three hospitals out of 51 performed significantly less pneumonectomies than expected (O/E ratio < 0.5) and three significantly more (O/E ratio > 1.7). In the latter group, severe complications were more frequent, taking other influencing factors into account (OR 1.51, 95% CI 1.05–2.19).ConclusionsThere is a considerable between-hospital variation in pneumonectomy use in lung cancer treatment. To further optimize surgical lung cancer care, we suggest center-specific feedback on pneumonectomy use and the development of a risk-adjusted pneumonectomy indicator.

Successful Sleeve Resection as a Marker for Proficiency for Robotic Pulmonary Resection.

Robot technology is a revolutionary technique to overcome limitations of minimal invasive surgery. The proficiency level varies from study to study. We considered the first sleeve lobectomy as a benchmark procedure to evaluate the proficiency level. We retrospectively analyzed 197 patients who underwent robot-assisted thoracoscopic surgery (RATS) for primary lung cancer between December 2011 and May 2018. Patients were divided into two groups based on undergoing surgery earlier period (EP) or later period (LP) than the first sleeve lobectomy by RATS (May 25, 2015). The preoperative, operative, and short- and long-term postoperative outcomes were compared. Seven-year survival was also compared between two periods for T1N0 and T2N0 diseases. Preoperative features were similar. The mean operative time was 166.8 ± 55.1 and 142.4 ± 43.9 minutes in EP and LP, respectively (p = 0.005). The mean number of dissected lymph nodes in LP was also significantly higher than that in EP (24.4 ± 9.4 vs. 20.8 ± 10.4, p = 0.035). The complication rate was significantly lower in LP (29/86 vs. 25/111, p = 0.048). The extended resection (ER) rate was significantly higher in LP (p = 0.023). The 7-year survival was comparable in EP and LP in both patients with T1N0 and T2N0 (p = 0.28 and p = 0.11, respectively). Perioperative outcomes, such as duration of surgery, number of dissected lymph nodes, complications, and ERs are favorable in patients who underwent surgeries after the first sleeve resection. The first sleeve lobectomy may be considered as the benchmark procedure for the proficiency level in RATS.

Complete thoracoscopic sleeve lobectomy for mucoepidermoid carcinoma in a 5-year-old boy.

Mucoepidermoid carcinoma (MEC) is a salivary gland tumor characterized by parotid differentiation (1). Pulmonary mucoepidermoid carcinoma (PMEC) originates from the small salivary glands of the bronchial trachea. PMEC is a kind of uncommon primary lung cancer with low incidence, accounts for about 0.1–1.0% of lung carcinoma (2,3), especially rare in children. Radical resection is considered as the best treatment modality due to its good prognosis results.

Pushing the limits in order to avoid pneumonectomy.

We have read with great interest the letter from Dr. Perentes and colleagues (1) with his comments about our recent paper (2). Dr. Perentes agrees with our results affirming that for the treatment of centrally located lung cancer sleeve lobectomy should be preferred over pneumonectomy even after induction treatment. Our paper included patients undergoing Y sleeve lobectomy after neoadjuvant chemotherapy.

Improved tolerance of radical lung surgery after contralateral diaphragmatic elevation correction in lung cancer patients: a stepwise approach

We report on a 69 years old man with an incidental finding of a suspicious mass in the left upper lobe, detected during treatment of a severe pneumonia. This patient had a known right sided idiopathic diaphragm paralysis and suffered from severe breathlessness. He was treated for endogenous depression and psychosis. Diaphragm plication was successfully performed 4 weeks before contralateral upper sleeve lobectomy in a difficult patient with comorbidities. This case illustrates a stepwise approach in restoration of adequate lung function before radical lung cancer surgery of the nonaffected side.

A Prolonged Air Leak Score for Lung Cancer Resection: An Analysis of The Society of Thoracic Surgeons General Thoracic Surgery Database

The objective of this study was to create a simple preoperative tool to assess the risk of prolonged air leak (PAL) using The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD). The STS GTSD was queried for patients who underwent elective lung cancer resection between 2009 and 2016. Exclusion criteria included pneumonectomy, sleeve lobectomy, chest wall resection, bilateral procedures, and patients with incomplete data sets. The primary outcome was PAL exceeding 5 days. Multivariable logistic regression was used to identify risk factors for a PAL. Model coefficients were used to generate a PAL score (PALS). The approach was cross-validated in 100 replications of a training set consisting of two-thirds of the cohort that was randomly selected and a validation set of remaining patients. A total of 52,198 patients from the STS GTSD met inclusion criteria, with an overall rate of PAL of 10.4% (n= 5453). Final variables incorporated into the PALS included body mass index of 25 kg/m2 or less (7 points), lobectomy or bilobectomy (6 points), forced expiratory volume in 1 second of 70% predicted or less (5 points), male sex (4 points), and right upper lobe procedure (3 points). A cumulative PALS exceeding 17 points stratified patients as high-risk or low-risk for PAL (19.6% vs 9% rate of PAL) with a cross-validated mean negative predictive value of 91%, positive predictive value of 19%, sensitivity of 30%, specificity of 85%, and correctly classifies 79% of patients. The PALS is a simple preoperative clinical tool that can reliably risk-stratify patients for PAL who are undergoing lung cancer resection.

The advantage of sleeve lobectomy over pneumonectomy.

The comment from Dr. Ludwig (1) to ore recent paper on lower sleeve lobectomy, the so-called “Y” sleeve (2), is interesting and it deals on some important points related to technical aspects in this setting. It is a pleasure to reply to an author that has published important contributions on sleeve lobectomy, reporting, over time, results from patients that had undergone sleeve lobectomy and pneumonectomy.

Upper lobe preservation is not a challenge.

We have particularly appreciated the interesting letter from Cohen and colleagues (1) with their comments about our recent paper (2). They underline the importance of the use of lung-sparing operations for the treatment of NSCLC in order to avoid pneumonectomy. In particular, the latter authors confirm our suggestion that even a particular and challenging-considered operation such as lower sleeve lobectomy can provide good short and long term results (3-6). In our study (2), we stressed the aspect that left lower sleeve lobectomy and right lower bilobectomy should have been considered as a peculiar subset among sleeve resections in order to better investigate the outcome after this kind of reconstructive operations that, up to our paper, were usually included as very small number in wider series of bronchial and bronchovascular reconstruction patients.

Technique and outcomes of 79 consecutive uniportal video-assisted sleeve lobectomies.

Uniportal video-assisted thoracic surgery (VATS) is well accepted by surgeons for anatomical major lung resections. However, large series evaluating the results, safety and efficacy of the technique for sleeve resections are still lacking. The aim of this study was to examine our experience with the use of uniportal VATS for sleeve resections. From September 2014 to January 2018, a total of 79 consecutive patients were offered uniportal VATS sleeve resection for centrally located tumours invading the orifice of the lobar bronchus or extending into the main stem bronchus by a single surgical team of the Thoracic Surgery Department of the Shanghai Pulmonary Hospital. Perioperative data were collected and analysed. Survival data were collected via telephone calls. Sixty-six of the 79 patients had a diagnosis of non-small-cell lung cancer, 47 of whom had squamous cell carcinoma. Twenty-one of the group with non-small-cell carcinoma were already at an advanced stage (III, IV) when operated on. The mean number of lymph node stations dissected was 5.5 ± 0.97 (4-8) and that of lymph nodes harvested was 13.7 ± 3.7 (5-23). A right upper lobectomy was the most common and time-consuming procedure. There was 1 conversion to a thoracotomy due to bleeding. No anastomotic-related complications were noted. The mean length of stay was 5.14 ± 1.56 (2-11) days. The 1- and 2-year survival rates were 98% and 80%, respectively. Uniportal VATS sleeve resection is a safe and efficient procedure for the treatment of centrally located tumours otherwise requiring a pneumonectomy.

Sleeve Lobectomy for Non-Small Cell Lung Cancers: Predictive CT Features for Resectability and Outcome Analysis.

OBJECTIVE. The purpose of this study was to investigate the CT features predictive of resectability in sleeve lobectomy (SL) for patients with non-small cell lung cancers (NSCLCs) and the outcomes of this procedure. MATERIALS AND METHODS. The study included 45 patients with NSCLCs who planned to undergo SL as a first-line surgical option and underwent SL or pneumonectomy between February 2014 and July 2017. The patients were dichotomized according to whether SL was achieved without residual disease. ROC curve and logistic regression analyses were performed to identify CT features predictive of resectability in SL without residual disease. For outcome analysis, postoperative complications and survival were compared between the two patient groups. RESULTS. SL was successfully performed in 25 patients (55.6%), whereas eight patients underwent SL but had a positive resection margin and 12 required pneumonectomy. The AUC value of the tumor-involved length of the salvage bronchus for SL without residual disease was 0.802, with 5 mm considered the optimal cutoff for this tumor-involved length. A tumor-involved length of 5 mm or less for the salvage bronchus representing the distal anastomosis end in SL was the sole significant predictor for resectability in SL without residual disease in logistic regression analysis (odds ratio, 16.0; 95% CI, 3.7-69.6; p < 0.001). The group of patients who underwent SL without residual disease tended to have a more favorable survival outcome than patients who underwent SL but had residual disease or those who underwent pneumonectomy (p = 0.110), but postoperative complication rates were similar between the two patient groups (20.0% vs 25.0%, respectively). CONCLUSION. A tumor-involved salvage bronchus length of 5 mm or less was a CT feature predictive of resectability in SL without residual disease, which may improve the survival of patients with NSCLCs.

Video-Assisted Vs Thoracotomy Sleeve Lobectomy for Lung Cancer: A Propensity Matched Analysis

In this retrospective study, we evaluated the safety and efficacy of video-assisted thoracic surgery (VATS) sleeve lobectomy for patients with centrally located non-small cell lung cancer. All consecutive patients who received VATS sleeve lobectomy (n= 54) and thoracotomy sleeve lobectomy (n= 94) were analyzed retrospectively; after propensity score matching, 78 paired cases were selected for further statistical analysis. Among all patients, the VATS group showed significantly better recurrence-free survival and overall survival than the thoracotomy group (P= .025 and P= .026, respectively) with smaller total tumor size and earlier pathological tumor-node-metastasis (TNM) stage. Nevertheless, after matching, the recurrence-free survival (50.9% vs 48.7%; P= .445) and overall survival (79.5% vs 66.7%; P= .198) were not significantly different. There was significantly less blood loss (228 vs 246 mL; P= .022), shorter thoracic drainage stay (4.6 vs 6.8 days; P < .001), and postoperative hospital stay (9.2 vs 11.3 days; P= .033) in the VATS group. Multivariate Cox analyses demonstrated that the surgical procedure was not an independent prognostic factor for recurrence-free survival, not only for patients with an invasive component size of 3 cm or less and negative lymphatic invasion, but for locally advanced patients with an invasive tumor size >3 cm (hazard ratio: 0.94; 95% confidence interval: 0.36-2.45; P= .55) or positive lymphatic invasion (hazard ratio: 0.91; 95% confidence interval: 0.35-2.39; P= .41). VATS sleeve lobectomy is a safe and effective procedure associated with better postoperative recovery and equivalent oncological results, even for locally advanced non-small cell lung cancer patients with an invasive tumor size larger than 3 cm or accompanying lymphatic invasion.

Robotic sleeve lobectomy for inflammatory tumour of left lung

Robotic sleeve lobectomy for inflammatory tumour of left lung