Favorable results after sleeve lobectomy or bronchoplasty for bronchial malignancies

Background. Sleeve lobectomy and bronchoplasty are established alternatives to pneumonectomy for bronchial malignancies involving a main bronchus. How ever, potential bronchial anastomotic complications have deterred the gener al application of these types of resection. Some reports have contained a m ixture of non-small cell lung cancer (NSCLC) and tumors of low-grade malign ancy, making it difficult to assess the long-term results of these procedur es as an alternative to pneumonectomy for lung cancer. Methods. We retrospectively reviewed our experience with sleeve lobectomy a nd bronchoplasty for bronchial malignancies from January 1988 to September 1998 separating NSCLC (n = 58) from tumors of low-grade malignancy (n = 19) . We compared the overall results between sleeve lobectomy and pneumonectom y (n = 142) performed for NSCLC over the same time interval. Results. For NSCLC, after sleeve lobectomy, the operative mortality was 5.2 % (3 of 58 patients) and the overall 5-year actuarial survival was 37.5%. A fter pneumonectomy, the operative mortality was 4.9% (7 of 142 patients) an d the overall 5-year actuarial survival was 35.8%. For tumors with low-grad e malignancy, there was no operative mortality after sleeve lobectomy or br onchoplasty and the 5-year actuarial survival was 100%. Major bronchial ana stomotic complications occurred in 3 patients among the 77 patients who und erwent sleeve resection. Conclusions. Sleeve resection can be performed with a low risk of bronchial anastomotic complication. The long-term survival after sleeve resection fo r NSCLC is similar to pneumonectomy. Excellent results are obtained after s leeve resection for low-grade malignancies. (C) 1999 by The Society of Thor acic Surgeons.