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The role of sleeve resections in advanced nodal disease
Journal article   Open access   Peer reviewed

The role of sleeve resections in advanced nodal disease

Joachim Schirren, Michael Eberlein, Andreas Fischer and Servet Bölükbas
European journal of cardio-thoracic surgery, Vol.40(5), pp.1157-1164
11/2011
DOI: 10.1016/j.ejcts.2011.02.037
PMID: 21454086
url
https://doi.org/10.1016/j.ejcts.2011.02.037View
Published (Version of record) Open Access

Abstract

Objective: The aim of this study was to compare the short-term and long-term results of sleeve resections depending on limited nodal disease (N0/N1, LND) and advanced nodal disease (N2/N3, AND) for non-small cell lung cancer (NSCLC) at a single institution. Methods: We retrospectively reviewed our prospective database of all NSCLC patients undergoing sleeve resections between January 1999 and December 2008. Patients' characteristics, morbidity, mortality, locoregional recurrence, distant recurrence, and survival were analyzed corresponding to LND and AND. Results: The indication was NSCLC for 170 sleeve resections (LND: n = 120; AND: n = 50) out of 213 consecutive sleeve resections. Both groups were statistically equal with regard to age (LND 61.8 ± 12.4 vs AND 60.8 ± 9.6 years), gender, co-morbidities, type of sleeve resection (bronchial vs bronchovascular), number of dissected lymph nodes (LND 40.0 ± 12.4 vs AND 36.7 ± 14.0), histology and completeness of resection (LND 96.7% vs AND 98.0%), respectively. More patients had induction chemotherapy in AND group (p = 0.049). The short-term results were equal on the subject of morbidity rate (LND: 34.2%, AND: 44.0%), secondary pneumonectomy (LND: 1.7%, AND: 4.0%), and mortality rate (LND: 5.0%, AND: 6.0%), respectively. LND was associated with a better 5-year-survival rate (LND: 67%; AND: 42%) and mean survival (LND: 80.8 months; AND: 37.7 months; p = 0.014). In the long-term follow-up, more distant metastases were detected in AND group (26.0% vs 14.2%, p = 0.079) in contrast to identical locoregional recurrence (LND: 1.7%; AND: 0%). In the event of metastazing, the mean time to the development of distant metastases was similar (LND: 19.1 months; AND: 12.4 months; p = 0.2). Conclusions: Lymph node involvement is a negative prognostic factor concerning long-term survival. Sleeve resections in AND do not result in higher morbidity and mortality. But even in AND, sleeve resections are associated with promising long-term survival and extraordinary local control of the disease as a result of high complete resection rates. High rate of distant failure warrants further investigation for the systemic control of the disease.
 Sleeve resection NSCLC Stage IIIA Stage IIIB

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