title: Bronchial sleeve resection or pneumonectomy for non-small cell lung cancer: a propensity-matched analysis of long-term results, survival and quality of life.
abstract: BACKGROUND
  No randomized studies exist comparing pneumonectomy (PN) and sleeve lobectomy (SL). We evaluated surgical results and long-term quality of life in patients operated on for central non-small cell lung cancer (NSCLC) using either SL or PN.
  
  
  METHODS
  A total of 641 NSCLC patients underwent surgery 2000-2010. SL was performed in 40 (6.2%) and PN in 67 (10.5%). In 2011, all surviving patients were sent a 15D Quality of Life Questionnaire which 83% replied. Propensity-score-matching analysis was utilized to compare the groups.
  
  
  RESULTS
  Thirty-two bronchial (18 right/14 left), seven vasculobronchial (3 right/4 left), one right wedge SL, and 18 right and 22 left PN were performed. Preoperatively, the Charlson Comorbidity Index (CCI) score, forced expiratory volume in 1 s (FEV1) and diffusion capacity did not differ between groups. The perioperative complication rate and pattern were similar, but SL group had less major complications (P<0.027). One perioperative death (2.5%) occurred in SL group and four (6%) in PN. The 90-day mortality rate was 5% (n=2) for SL and 7.5% (n=5) for PN. In the follow-up total cancer recurrence did not differ (P=0.187). Quality of life measured by 15D showed no significant difference in separate dimensions or total score, except tendency to favor SL in moving or breathing. The 5-year survival did not differ between groups (P=0.458), but no deaths were observed in SL group after 5 years.
  
  
  CONCLUSIONS
  Due to less major operative complications and better long-term survival, we would advocate using SL when feasible, but in patients tolerating PN it should be considered if SL seems not to be oncologically sufficiently radical.
authors.affiliation: Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland.
authors.forename: Saana E M
authors.initials: SE
authors.lastname: Andersson
authors.affiliation: Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland.
authors.forename: Ville H S
authors.initials: VH
authors.lastname: Rauma
authors.affiliation: Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland.
authors.forename: Eero I
authors.initials: EI
authors.lastname: Sihvo
authors.affiliation: Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland.
authors.forename: Jari V
authors.initials: JV
authors.lastname: Räsänen
authors.affiliation: Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland.
authors.forename: Ilkka K
authors.initials: IK
authors.lastname: Ilonen
authors.affiliation: Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland.
authors.forename: Jarmo A
authors.initials: JA
authors.lastname: Salo
keywords: Bronchial sleeve resection; analysis; long-term survival; non-small cell lung cancer (NSCLC); pneumonectomy (PN); quality of life