Prospective Study on Perioperative Risks and Functional Results in Bronchial and Bronchovascular Sleeve Resections

Abstract

Background: Most reports on sleeve resections are based on a retrospective analysis over a long period of many decades. This prospective study addresses the challenging questions associated with sleeve resection. Methods: In a prospective study, 100 consecutive patients undergoing bronchial or bronchovascular sleeve resection with systematic lymph node dissection were analyzed: operative procedures, extended lymph node dissection, bronchial and vascular complications, functional results, recurrence and survival were recorded. Results: 100 patients (male 78, female 22, age 60.0 ± 11.9) were enrolled in this study. A R0 resection rate of 99 % could be achieved and pneumonectomies avoided using 9 different surgical techniques. The average number of dissected lymph nodes was 30 on the right side and 33 on the left side. Morbidity and mortality were 39 % and 2 %, respectively. The main indication was non-small cell lung cancer (74 %). The local and distant recurrence rates were 1 % and 16 %, respectively. The overall 5-year survival rate was 87 %. Long-term survival differed significantly between N0 and N1 status (p = 0.027) and N0 and N2 status (p = 0.029), but not between N1 and N2 status (p = 0.754). There were no relevant differences in pre- and postoperative perfusion scans and FEV₁ at 6 months after surgery. Conclusions: In the hands of experienced surgeons bronchial and bronchovascular sleeve resections are safe operations for high-risk patients. There is no statistical significance between N1 and N2 disease with regard to long-term survival. Systematic lymph node dissection does not lead to increased perioperative risk. Sleeve resections have little effect on pulmonary function. Preoperative FEV₁ and lung perfusion can be achieved by 6 months after surgery.

Key words

sleeve resection - functional results - NSCLC - perfusion - perioperative risk - lymph node dissection

References

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