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Gregory J. Riely, MD, PhD
Gregory J. Riely, MD, PhD
Posted: Tuesday, July 2, 2024
Based on a retrospective cohort analysis published in the Journal of Cardiothoracic Surgery, patients with central non–small cell lung cancer (NSCLC) of the right lower lobe who underwent right lower sleeve lobectomy vs right lower bilobectomy demonstrated fewer major complications, smaller postoperative residual air spaces, and comparable long-term survival outcomes. Zhixin Li, MD, of Tongji University, Shanghai, and colleagues highlighted the potential of this middle lobe–sparing strategy as an alternative for select populations at experienced centers.
“Although it is true that sleeve lobectomy is technically more demanding than bilobectomy, sleeve resection has gradually been an attractive procedure chosen by experienced thoracic surgeons for patients with lung cancer because of progress of technology and equipment,” the investigators remarked. “Besides, bilobectomy, especially lower bilobectomy, incurs high morbidity and mortality.”
The investigators identified 296 and 49 patients who underwent bilobectomy and sleeve lobectomy, respectively, between January 2014 and January 2020 at the Shanghai Pulmonary Hospital. A total of 41 pairs were subsequently propensity-matched in a 1:1 ratio; among the two groups, no significant differences in demographic characteristics were found.
Major postoperative complications were documented in 31.7% of the patients who underwent bilobectomy vs 12.1% of those who had sleeve lobectomy (P = .032). Bilobectomy seemed to confer a significantly higher rate of intervention for surgical residual cavity (21.9% vs 7.3%; P = .037). Both the postoperative right lateral (P = .026) and overall (P = .001) lung volume were found to be significantly larger in patients who underwent the middle lobe–sparing procedure.
The investigators acknowledged the limitations of their study, which included selection bias given its retrospective nature and the relatively limited number of cases. A prospective clinical trial in the future is warranted to validate the possible benefit of lung function with right lower sleeve resection, they proposed.
Disclosure: The study authors reported no conflicts of interest.
Journal of Cardiothoracic Surgery
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