Sleeve lobectomy or pneumonectomy: optimal management strategy using decision analysis techniques.
BACKGROUND
The choice between sleeve lobectomy and pneumonectomy is controversial for patients with early-stage lung cancer and who have acceptable lung function.


METHODS
We performed a meta-analysis of results of sleeve lobectomy and pneumonectomy published in English from 1990 to 2003. A decision model was developed with 5-year survival, quality-adjusted life years (QALY), and cost effectiveness as the outcomes, and sensitivity analyses were performed.


RESULTS
The model favored sleeve lobectomy (3.5 percentage point survival advantage) when the reward was 5-year survival; the results were influenced primarily by the 5-year survival rates for patients who did not develop recurrent cancer. Sleeve lobectomy was strongly favored when the reward was QALY (1.53 QALY advantage). Sleeve lobectomy was more cost effective than pneumonectomy, and had an incremental cost effectiveness ratio of $1,300/QALY.


CONCLUSIONS
In patients with anatomically appropriate early-stage lung cancer, sleeve lobectomy offers better long-term survival and quality of life than does pneumonectomy and is more cost effective.
Ferguson
Mark K
MK
Department of Surgery, The University of Chicago, Chicago, Illinois 60637, USA. mferguso@surgery.bsd.uchicago.edu
Lehman
Amy G
AG
D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015233:Models, Statistical; D009364:Neoplasm Recurrence, Local; D011013:Pneumonectomy / Q000191:economics / Q000379:methods*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D015996:Survival Rate