Survival and prognostic factors in patients undergoing parenchymal saving bronchoplastic operation for primary lung cancer: a series of 110 consecutive cases

Objective: The purpose of this study was to report our experience concernin g bronchial sleeve lobectomy for treating bronchogenic cancer. Method: From 1980 to 1994, 110 patients underwent bronchial sleeve lobectomy for bronch ogenic cancer. In 45 patients, preoperative investigations contraindicated pneumonectomy, whereas in 65 other patients, sleeve resection was performed without functional necessity. The most common procedures were sleeve lobec tomy of the right upper lobe (64%), and of the left upper lobe (21%). Sixte en patients (15%) underwent additional arterial vascular resection. Seven p atients had microscopic invasion of the bronchial margin without the possib ility of further resection in six with regard to their limited respiratory function. Tumors were staged as follow: 32 stage IB (all T2 N0), 57 stage I IB (57T2 N1), and 17 stage IIIA (eight, T3N1; nine, T2N2), whereas four pat ients had an in situ cancer (four stage 0). Results: Operative mortality wa s 2.75%. The 5- and 10-year actuarial survival rates were, respectively, 39 and 22% for the entire group. The 5-year actuarial survival rates were, 60 % in stage IB, 30% in stage IIB, and 27% in stage IIIA. Four factors signif icantly influenced survival (P < 0.05): nodal stage, arterial resection, in vasion of the bronchial stump and poor functional respiratory status contra indicating pneumonectomy. Conclusions: In our experience, sleeve resection for stage I provides comparable survival to that of standard resection at e qual stage. However, in patients with pathologically N1 disease, who can to lerate a pneumonectomy, a randomized study is mandatory to confirm that sle eve lobectomy can be performed without the risk of decreasing long-term sur vival. In our study, patients who required an associated vascular resection demonstrated a poor survival. (C) 1999 Elsevier Science B.V. All rights re served.