Bronchial and bronchovascular sleeve resection for treatment of central lung tumors

Background. To improve postoperative pulmonary reserve, we have employed parenchyma-sparing resections for central lung tumors irrespective of pulmonary function. The results of lobectomy, pneumonectomy, and sleeve resection were analyzed retrospectively. Methods. From October 1995 to Tune 1999, 422 typical lung resections were performed for lung cancer. Of these, 301 were lobectomies (group I), 81 were sleeve resections (group II), and 40 were pneumonectomies (group III). Results. Operative mortality was 2% in group I, 1.2% in group II, and 7.5% in group III (group I and II vs group III, p < 0.03). Mean time of intubation was 1.0 +/- 4.1 days in group I, 0.9 +/- 1.3 days in group II, and 3.6 +/- 11.2 days in group III (groups I and II vs group III, p < 0.01). The incidence of bronchial complications was 1.3% in group I, none in group II, and 7.5% in group III (group I and II vs group III, p < 0.001). After 2 years, survival was 64% in group I, 61.9% in group II, and 56.1% in group III (p NS). Freedom from local disease recurrence was 92.1% in group I, 95.7% in group II, and 90.9% in group III after 2 years (p = NS). Conclusions. Sleeve resection is a useful surgical option for the treatment of central lung tumors, thus avoiding pneumonectomy with its associated risks. Morbidity, early mortality, long-term survival, and recurrence of disease after sleeve resection are similar to those seen after lobectomy. (C) 2000 by The Society of Thoracic Surgeons.