Survival related to lymph node involvement in lung cancer after sleeve lobectomy compared with pneumonectomy

Objective: The purpose of this study was to compare the outcomes after slee ve lobectomy and pnenmonectomy for patients with non-small cell lung cancer distributed according to their nodal involvement status, Methods: Of 1172 patients in whom primary non-small cell lung carcinoma, in cluding mediastinal lymph nodes, was completely excised, 151 patients: unde rwent sleeve lobectomy and 60 underwent pneumonectomy. For bias reduction i n comparison with a nonrandomized control group, we paired 60 patients unde rgoing sleeve lobectomy with 60 patients undergoing pneumonectomy by using the nearest available matching method. Results: The 30-day postoperative mortality was 2% (1160) in the pneumonect omy group and 0% in the sleeve lobectomy group, Postoperative complications occurred in 13% of patients in the sleeve lobectomy group and in 22% of th ose in the pneumonectomy group. Local recurrences occurred in 8% of patient s in the sleeve lobectomy group and in 10% of those in the pneumonectomy gr oup. The overall 5- and 10-year survivals for the sleeve lobectomy group we re 48% and 36%, respectively, whereas those for the pneumonectomy group wer e 28% and 19%, respectively (P = .005), Multivariable analysis showed that the operative procedure, T factor, and N factor were significant independen t prognostic factors and revealed that survival after sleeve lobectomy was significantly longer than that after pneumonectomy (P = .03), Conclusions: These data suggest that sleeve lobectomy should be performed i nstead of pneumonectomy in patients with nun-small cell lung cancer regardl ess of their nodal status whenever complete resection can be achieved becau se this is a lung-saving procedure with lower postoperative risks and is as curative as pneumonectomy.