Sleeve lobectomy compared to pneumonectomy for the treatment of N0-N1 non-small cell lung cancer

OBJECTIVE: To compare survival, morbidity, and mortality rates for a series of patients who underwent either bronchoplastic sleeve lobectomy or pneumonectomy to treat non-small cell lung cancer (NSCLC). PATIENTS AND METHOD: We reviewed the clinical records for patients who underwent sleeve lobectomy or pneumonectomy for NSCLC from January 1994 through December 2003. RESULTS: From January 1994 through December 2003, 35 sleeve lobectomies and 220 pneumonectomies were performed at our department on patients with NSCLC. The perioperative mortality rate was 2.8% for the lobectomy group and 9.1% for the pneumonectomy group. The mean survival time for the pneumonectomy group was 45 months (95% confidence interval [CI], 37-53), with a 5-year survival rate of 32% (SE, 5.1%). The mean survival time for the sleeve lobectomy group was 72 months (95% CI, 56-87) (P <=.0041), with a 5-year survival rate of 56% (SE, 9.6%). If we stratify the groups according to node involvement, patients classified as NO-NI had a mean survival time of 52 months (95% CI, 43-61), with a 5-year survival rate of 39% (SE, 6.2%) for the pneumonectomy group. The mean survival time for patients undergoing sleeve lobectomy was 75 months (95% CI, 59-92) (P <=.018), with a 5-year survival rate of 60% (SE, 10.4%). Survival for patients with N2 disease was similar to that of patients with NO-NI disease. CONCLUSION: For patients with N0-N1 non-small cell lung cancer, sleeve lobectomy offers better survival than pneumonectomy.