title: Is sleeve lobectomy comparable in terms of short- and long-term results with pneumonectomy after induction therapy? A multicenter analysis.
abstract: BACKGROUND
  Sleeve lobectomy (SL) is considered a valid therapeutic option in untreated, centrally located non-small cell lung cancer (NSCLC) even in patients "fit" for pneumonectomy (PN). Nevertheless, SL feasibility and long-term results after induction therapy (IT) have been only rarely investigated. We herein report the results of a multicenter retrospective study on NSCLC patients who underwent PN or SL after IT for locally advanced NSCLC.
  
  
  METHODS
  From January 1992 to January 2012, 119 consecutive patients (94 males, 25 females) underwent in three tertiary referral centers either SL (bronchial, arterial, or both) or PN for locally advanced NSCLC after IT (chemotherapy alone or combined chemoradiotherapy). The indication for SL was based on technical feasibility. Clinical and pathologic variables were retrospectively reviewed, and treatment results were assessed and compared in both groups. Survival was calculated by Kaplan-Meier method and compared by the log-rank test as well the Cox regression model.
  
  
  RESULTS
  Sleeve lobectomy was performed in 51 patients and PN, in 68 patients. Thirty-day mortality and morbidity rates were 3.9% and 9.8% for SL and 2.9% and 22.1% for PN, respectively. Five-year survival rates were 53.8% after SL and 43.1% after PN, respectively (p = 0.28). Overall recurrence rate was 42.8% after SL and 47.0% after PN (p = 0.34); relapse was locoregional in 22.4% of SL cases and 12.1% after PN, respectively (p = 0.011). The Cox analysis suggested pN status and right side as independent risk factors for death in the SL group (hazard ratio, 1.96; 95% confidence interval, 1.12 to 3.44; p = 0.018; and hazard ratio, 2.96; 95% confidence interval, 1.13 to 8.66; p = 0.047, respectively). As well, pN status and right side were a strong predictor of relapse (hazard ratio, 2.33; 95% confidence interval, 1.17 to 4.64; p = 0.016; and hazard ratio, 2.96; 95% confidence interval, 1.13 to 8.66; p = 0.046, respectively) in SL patients.
  
  
  CONCLUSIONS
  For locally advanced NSCLC, SL represents a safe and effective surgical option when compared with PN even after IT, with substantially comparable early and long-term results. Nevertheless, further investigations on a large cohort of patients are needed.
authors.affiliation: General Thoracic Surgery, Catholic University, Rome, Italy; General Thoracic Surgery "Vittorio Emanuele-Policlinico" Hospital, Catania, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Cusumano
authors.affiliation: General Thoracic Surgery, Niels Stensen Clinics, Ostercappeln, Germany.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marra
authors.affiliation: Unit of Thoracic Surgery, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Electronic address: filippo_lococo@yahoo.it.
authors.forename: Filippo
authors.initials: F
authors.lastname: Lococo
authors.affiliation: General Thoracic Surgery, Catholic University, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Margaritora
authors.affiliation: General Thoracic Surgery, Catholic University, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Siciliani
authors.affiliation: General Thoracic Surgery, Sapienza University Sant'Andrea Hospital, Rome, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Maurizi
authors.affiliation: General Thoracic Surgery, Sapienza University Sant'Andrea Hospital, Rome, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Poggi
authors.affiliation: General Thoracic Surgery, Niels Stensen Clinics, Ostercappeln, Germany.
authors.forename: Ludger
authors.initials: L
authors.lastname: Hillejan
authors.affiliation: General Thoracic Surgery, Sapienza University Sant'Andrea Hospital, Rome, Italy; Fondazione Eleonora Lorillard Spencer Cenci, Rome, Italy.
authors.forename: Erino
authors.initials: E
authors.lastname: Rendina
authors.affiliation: General Thoracic Surgery, Catholic University, Rome, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Granone
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis