Prospective study on perioperative risks and functional results in bronchial and bronchovascular sleeve resections.
BACKGROUND
Most reports on sleeve resections are based on a retrospective analysis over a long period of many decades. This prospective study addresses the challenging questions associated with sleeve resection.


METHODS
In a prospective study, 100 consecutive patients undergoing bronchial or bronchovascular sleeve resection with systematic lymph node dissection were analyzed: operative procedures, extended lymph node dissection, bronchial and vascular complications, functional results, recurrence and survival were recorded.


RESULTS
100 patients (male 78, female 22, age 60.0 +/- 11.9) were enrolled in this study. A R0 resection rate of 99 % could be achieved and pneumonectomies avoided using 9 different surgical techniques. The average number of dissected lymph nodes was 30 on the right side and 33 on the left side. Morbidity and mortality were 39 % and 2 %, respectively. The main indication was non-small cell lung cancer (74 %). The local and distant recurrence rates were 1 % and 16 %, respectively. The overall 5-year survival rate was 87 %. Long-term survival differed significantly between N0 and N1 status ( P = 0.027) and N0 and N2 status ( P = 0.029), but not between N1 and N2 status ( P = 0.754). There were no relevant differences in pre- and postoperative perfusion scans and FEV (1) at 6 months after surgery.


CONCLUSIONS
In the hands of experienced surgeons bronchial and bronchovascular sleeve resections are safe operations for high-risk patients. There is no statistical significance between N1 and N2 disease with regard to long-term survival. Systematic lymph node dissection does not lead to increased perioperative risk. Sleeve resections have little effect on pulmonary function. Preoperative FEV (1) and lung perfusion can be achieved by 6 months after surgery.
Schirren
J
J
Department of Thoracic Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany. J.Schirren@kerckhoff-klinik.de
Bölükbas
S
S
Bergmann
T
T
Fisseler-Eckhoff
A
A
Trainer
S
S
Beqiri
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001980:Bronchi / Q000601:surgery*; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000503:physiopathology*; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013510:Pulmonary Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D020127:Recovery of Function; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult