Extended Sleeve Lobectomy is an Alternative For Centrally Located Lung Cancer With Superior Short- and Long- Term Outcomes.

Objectives Extended sleeve lobectomy (ESL) is a feasible alternative to pneumonectomy; however, the survival benefit is unclear and preoperative selection of potential candidates for ESL remains a problem. Methods ESL was performed on selected candidates with double sleeve lobectomy for more than one lobe (e.g. Left upper lobe and S6 segment resection). Three-dimensional (3-D) reconstruction was routinely validated. Patients were candidates for ESL if the predicted distal stump length was >6 mm and the pulmonary vein of the remaining segments was not invaded. Results Of the 1809 patients with centrally located lung cancer for surgical resection, 86 patients with tumors invading more than one lobe were enrolled in the study. After evaluation by 3-D reconstruction, 22 of 23 (95.7%) selected candidates underwent ESL, and 63 patients were deemed unsuitable for ESL and underwent pneumonectomy (43 cases) or thoracic exploration (20 cases). Surgical outcomes between the ESL and pneumonectomy groups were similar in terms of complications, blood loss and surgical duration, but the 6-minute walking distance was significantly improved in the ESL group (371±111m, 191±55 m, p<0.001). The mean FEV1 was 1.6±0.3L at the 1-year follow up examination in the ESL group. In the survival analysis, no difference was observed between the ESL and pneumonectomy groups in terms of 3-year overall survival (85% vs. 89%, respectively; p= 0.626) and 3-year disease-free survival (75% vs. 76%, respectively; p=0.625). Conclusions ESL is a feasible and superior surgical procedure in terms of its short-term and long-term outcomes, and we suggest 3-D reconstruction to identify candidates for ESL.