A Multicenter Retrospective Case-Control Study on Simple versus Extended Sleeve Lobectomies

Sleeve resection is currently the gold standard procedure for centrally located non-small cell lung cancer (NSCLC). Extended sleeve lobectomies(ESL) consist in an atypical bronchoplasty with resection of more than one lobe, and carry several technical difficulties compared to simple sleeve lobectomy(SSL). Our study aimed to compare the outcomes of ESL and SSL for NSCLC.This multicenter, retrospective, cohort study included 1314 patients who underwent ESL (155 patients) or SSL (1159 patients) between 2000 and 2018. The primary endpoints were: 30-day and 90-day mortality; overall survival(OS); Disease recurrence(DFS); complications.No differences were found between the two groups in terms of general characteristics and surgical and survival outcomes. In particular, there were no differences in terms of early and late complication frequency, 30 and 90-day mortality, R-status, recurrence, OS (54.26±33.72vs56.42±32.85 months,p=0.444) and DFS (46.05±36.14vs47.20±35.78 months,p=0.710). Mean tumor size was larger in the ESL group (4.72±2.30vs3.81±1.78 cm,p<0.001). Stage IIIA was the most prevalent stage in ESL group (34.8%), while stage IIB was the most prevalent in SSL group (34.3%)(p<0.001). In the multivariate analyses, nodal status was found to be the only independent predictive factor for overall survival.ESL gives comparable short- and long term outcomes to SSL. Appropriate preoperative staging and exclusion of metastases to mediastinal lymph nodes, as well as complete (R0) resection are essential for good long-term outcomes.