Sleeve Lobectomy for Non–Small Cell Lung Cancers: Predictive CT Features for Resectability and Outcome Analysis
Jong Hyuk Lee1,2, Soon Ho Yoon1, Young Tae Kim3, Chang Hyun Kang3 ... Show all
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Citation: American Journal of Roentgenology: 1-10. 10.2214/AJR.19.21258
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ABSTRACT :
OBJECTIVE. The purpose of this study was to investigate the CT features predictive of resectability in sleeve lobectomy (SL) for patients with non–small cell lung cancers (NSCLCs) and the outcomes of this procedure.

MATERIALS AND METHODS. The study included 45 patients with NSCLCs who planned to undergo SL as a first-line surgical option and underwent SL or pneumonectomy between February 2014 and July 2017. The patients were dichotomized according to whether SL was achieved without residual disease. ROC curve and logistic regression analyses were performed to identify CT features predictive of resectability in SL without residual disease. For outcome analysis, postoperative complications and survival were compared between the two patient groups.

RESULTS. SL was successfully performed in 25 patients (55.6%), whereas eight patients underwent SL but had a positive resection margin and 12 required pneumonectomy. The AUC value of the tumor-involved length of the salvage bronchus for SL without residual disease was 0.802, with 5 mm considered the optimal cutoff for this tumor-involved length. A tumor-involved length of 5 mm or less for the salvage bronchus representing the distal anastomosis end in SL was the sole significant predictor for resectability in SL without residual disease in logistic regression analysis (odds ratio, 16.0; 95% CI, 3.7–69.6; p < 0.001). The group of patients who underwent SL without residual disease tended to have a more favorable survival outcome than patients who underwent SL but had residual disease or those who underwent pneumonectomy (p = 0.110), but postoperative complication rates were similar between the two patient groups (20.0% vs 25.0%, respectively).

CONCLUSION. A tumor-involved salvage bronchus length of 5 mm or less was a CT feature predictive of resectability in SL without residual disease, which may improve the survival of patients with NSCLCs.

Keywords: CT, pneumonectomy, prediction, salvage bronchus, sleeve lobectomy

References

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1. Fadel E, Yildizeli B, Chapelier AR, Dicenta I, Mussot S, Dartevelle PG. Sleeve lobectomy for bronchogenic cancers: factors affecting survival. Ann Thorac Surg 2002; 74:851–858; discussion, 858–859 [Crossref] [Medline] [Google Scholar]
2. Predina JD, Kunkala M, Aliperti LA, Singhal AK, Singhal S. Sleeve lobectomy: current indications and future directions. Ann Thorac Cardiovasc Surg 2010; 16:310–318 [Medline] [Google Scholar]
3. Deslauriers J, Grégoire J, Jacques LF, Piraux M, Guojin L, Lacasse Y. Sleeve lobectomy versus pneumonectomy for lung cancer: a comparative analysis of survival and sites or recurrences. Ann Thorac Surg 2004; 77:1152–1156; discussion, 1156 [Crossref] [Medline] [Google Scholar]
4. Ludwig C, Stoelben E, Olschewski M, Hasse J. Comparison of morbidity, 30-day mortality, and long-term survival after pneumonectomy and sleeve lobectomy for non-small cell lung carcinoma. Ann Thorac Surg 2005; 79:968–973 [Crossref] [Medline] [Google Scholar]
5. Shi W, Zhang W, Sun H, Shao Y. Sleeve lobectomy versus pneumonectomy for non-small cell lung cancer: a meta-analysis. World J Surg Oncol 2012; 10:265 [Crossref] [Medline] [Google Scholar]
6. Maurizi G, D'Andrilli A, Anile M, et al. Sleeve lobectomy compared with pneumonectomy after induction therapy for non-small-cell lung cancer. J Thorac Oncol 2013; 8:637–643 [Crossref] [Medline] [Google Scholar]
7. Lim E, Baldwin D, Beckles M, et al.; British Thoracic Society; Society for Cardiothoracic Surgery in Great Britain and Ireland. Guidelines on the radical management of patients with lung cancer. Thorax 2010; 65(Suppl 3):iii1–iii27 [Crossref] [Google Scholar]
8. Gómez-Caro A, Garcia S, Reguart N, et al. Determining the appropriate sleeve lobectomy versus pneumonectomy ratio in central non-small cell lung cancer patients: an audit of an aggressive policy of pneumonectomy avoidance. Eur J Cardiothorac Surg 2011; 39:352–359 [Crossref] [Medline] [Google Scholar]
9. Kim YT, Kang CH, Sung SW, Kim JH. Local control of disease related to lymph node involvement in non-small cell lung cancer after sleeve lobectomy compared with pneumonectomy. Ann Thorac Surg 2005; 79:1153–1161; discussion, 1153–1161 [Crossref] [Medline] [Google Scholar]
10. Ma Z, Dong A, Fan J, Cheng H. Does sleeve lobectomy concomitant with or without pulmonary artery reconstruction (double sleeve) have favorable results for non-small cell lung cancer compared with pneumonectomy? A meta-analysis. Eur J Cardiothorac Surg 2007; 32:20–28 [Crossref] [Medline] [Google Scholar]
11. Kutlu CA, Goldstraw P. Tracheobronchial sleeve resection with the use of a continuous anastomosis: results of one hundred consecutive cases. J Thorac Cardiovasc Surg 1999; 117:1112–1117 [Crossref] [Medline] [Google Scholar]
12. Bagan P, Berna P, Pereira JCDN, et al. Sleeve lobectomy versus pneumonectomy: tumor characteristics and comparative analysis of feasibility and results. Ann Thorac Surg 2005; 80:2046–2050 [Crossref] [Medline] [Google Scholar]
13. Melloul E, Egger B, Krueger T, et al. Mortality, complications and loss of pulmonary function after pneumonectomy vs. sleeve lobectomy in patients younger and older than 70 years. Interact Cardiovasc Thorac Surg 2008; 7:986–989 [Crossref] [Medline] [Google Scholar]
14. Martin-Ucar AE, Chaudhuri N, Edwards JG, Waller DA. Can pneumonectomy for non-small cell lung cancer be avoided? An audit of parenchymal sparing lung surgery. Eur J Cardiothorac Surg 2002; 21:601–605 [Crossref] [Medline] [Google Scholar]
15. Ferguson MK, Lehman AG. Sleeve lobectomy or pneumonectomy: optimal management strategy using decision analysis techniques. Ann Thorac Surg 2003; 76:1782–1788 [Crossref] [Medline] [Google Scholar]
16. Guan Y, Huang J, Xia T, You X, He J, He J. Pre-operative evaluation of stage T3, central-type non-small cell lung cancer with double sleeve lobectomy under complete video-assisted thoracoscopic surgery using spiral computed tomography post-processing techniques. J Thorac Dis 2016; 8:1738–1746 [Crossref] [Medline] [Google Scholar]
17. Amin MB, Greene FL, Edge SB, et al. The eighth edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin 2017; 67:93–99 [Crossref] [Medline] [Google Scholar]
18. Mi W, Zhang C, Wang H, et al. Measurement and analysis of the tracheobronchial tree in Chinese population using computed tomography. PLoS One 2015; 10:e0123177 [Crossref] [Medline] [Google Scholar]
19. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205–213 [Crossref] [Medline] [Google Scholar]
20. Katayama H, Kurokawa Y, Nakamura K, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today 2016; 46:668–685 [Crossref] [Medline] [Google Scholar]
21. Patterson GCJ, Deslauriers J, Lerut A, Luketich J, Rice T. Pearson's thoracic & esophageal surgery, 3rd ed. Philadelphia, PA: Churchill Livingstone, 2008:894–908 [Google Scholar]
22. Kaiser L, Kron IL, Spray TL. Mastery of cardiothoracic surgery. Philadelphia, PA: Lippincott Williams & Wilkins, 1998:68–76 [Google Scholar]
23. Lee JW, Son JS, Choi JW, Han YJ, Lee J-R. The comparison of the lengths and diameters of main bronchi measured from two-dimensional and three-dimensional images in the same patients. Korean J Anesthesiol 2014; 66:189–194 [Crossref] [Medline] [Google Scholar]
Address correspondence to S. H. Yoon (yshoka@gmail.com).



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