title: Sleeve lobectomy for non-small cell lung cancer with N1 nodal disease does not compromise survival.
abstract: BACKGROUND
  We evaluated if sleeve lobectomy had worse survival compared with pneumonectomy for non-small cell lung cancer (NSCLC) with N1 disease, which may be a risk factor for locoregional recurrence.
  
  
  METHODS
  Patients who underwent pneumonectomy or sleeve lobectomy without induction treatment for T2-3 N1 M0 NSCLC at a single institution from 1999 to 2011 were reviewed. Survival distribution was estimated with the Kaplan-Meier method, and multivariable Cox proportional hazards regression was used to evaluate the effect of resection extent on survival.
  
  
  RESULTS
  During the study period, 87 patients underwent pneumonectomy (52 [60%]) or sleeve lobectomy (35 [40%]) for T2-3 N1 M0 NSCLC. Pneumonectomy and sleeve lobectomy patients had similar mean ages (60.9 ± 10.7 vs 63.5 ± 12.7 years, p = 0.30), gender distribution (69.2% [36 of 52] vs 60.0% [21 of 35] male, p = 0.37), mean forced expiratory volume in 1 second (66.3 ± 15.9 vs 63.5 ± 17.6, p = 0.47), stage (61.5% [32 of 52] vs 62.9% [22 of 35] stage II, p = 0.90), and tumor grade (51.9% [27 of 52] vs 31.4% [11 of 35] well/moderately differentiated, p = 0.17). Postoperative mortality (3.8% [2 of 52] vs 5.7% [2 of 35], p = 0.68) and median (interquartile range) length of stay (5 [4 to 7] vs 5 [4 to 7] days, p = 0.68) were similar between the two groups. The 3-year survival after pneumonectomy (46.8% [95% CI, 31.8% to 60.4%]) and sleeve lobectomy (65.2% [95% CI, 45.5% to 79.3%]) was not significantly different (p = 0.23). In multivariable survival analysis that included resection extent, age, stage, and grade, only increasing age predicted worse survival (hazard ratio, 1.03/year; p = 0.03).
  
  
  CONCLUSIONS
  Performing sleeve lobectomy instead of pneumonectomy for NSCLC with N1 nodal disease does not compromise long-term survival.
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: berry037@mc.duke.edu.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina; Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Worni
authors.affiliation: Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, North Carolina.
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Onaitis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008168:Lung / Q000601:surgery*; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009657:North Carolina; D010149:Postoperative Pain / Q000503:physiopathology; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
keywords: 10