title: Extended sleeve lobectomy: one more step toward avoiding pneumonectomy in centrally located lung cancer.
abstract: BACKGROUND
  The purpose of this study was to evaluate surgical outcomes of extended sleeve lobectomy (ESL) in centrally located non-small-cell lung cancer (NSCLC), sparing lung tissue and aggressively avoiding pneumonectomy.
  
  
  METHODS
  Patients who underwent ESL between January 2006 and January 2013 were included prospectively. An atypical bronchial anastomosis was used for sleeve lobectomy involving additional lobes or segments.
  
  
  RESULTS
  We included 27 patients, aged 62.7 ± 8.2 years (range, 49-83 years), with a forced expiratory volume in 1 second (FEV1) of 2.27 ± 0.6 (range, 1.6-2.7). According to the Okada classification, 16 cases were type A (right upper lobe + middle lobe ± segment 6), 7 cases were type B (left upper lobe + segment 6), and 2 cases were type C (left lower lobe + segments 4-5); we additionally classified 2 patients with right lower lobe tumors involving the right main bronchus as type D (right lower lobe + middle lobe). Anastomosis was performed between the right superior and right main bronchial stumps. Eleven patients underwent combined pulmonary angioplasties. Complete resection was achieved in all cases. There were no operative deaths. Mean segment reimplantation was 4.5 ± 0.84 (range, 3-6), resulting in a mean FEV1 improvement of 0.620 ± 0.16 (right-sided ESL) and 0.393 ± 0.21 (left-sided ESL). The complication rate was 25% (no immediate anastomosis-related complications; 1 case of delayed bronchial stenosis). No local recurrence was reported. At 6 months, mean FEV1 was 1.5 ± 0.4 (right-sided ESL) and 1.4 ± 0.3 (left-sided ESL). Mean follow-up time was 28 ± 19 months (range, 7-72 months). Overall 5-year survival was 62%.
  
  
  CONCLUSIONS
  In patients with centrally located NSCLC, lung-sparing ESL, whose safety and reliability rival that of pneumonectomy, should be considered. Functional effectiveness is higher with right-sided than with left-sided ESL.
authors.affiliation: General Thoracic Surgery Department, Hospital Clinic, Universidad de Barcelona, Barcelona, Spain; U1046, INSERM, Université Montpellier 1, Université Montpellier 2, Montpellier, France. Electronic address: jeanphilippe.berthet@gmail.com.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Berthet
authors.forename: Marina
authors.initials: M
authors.lastname: Paradela
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Jimenez
authors.forename: Laureano
authors.initials: L
authors.lastname: Molins
authors.forename: Abel
authors.initials: A
authors.lastname: Gómez-Caro
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001980:Bronchi / Q000601:surgery*; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging / Q000379:methods; D011013:Pneumonectomy / Q000379:methods*; D049268:Positron-Emission Tomography; D015203:Reproducibility of Results; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: 10