The surgical outcome of standard lobectomy versus sleeve lobectomy in patients with lung cancer: Propensity score matching

Introduction: Sleeve lobectomy is a parenchyma-sparing surgical procedure for tumors located centrally in the lung. In this study, we aimed to compare our patients who underwent conventional or sleeve lobectomy in our clinic for non-small cell lung cancer in terms of general characteristics, postoperative outcomes, survival and prognostic factors. Patients and Methods: A total of 476 patients who underwent 196 sleeve lobectomy and 280 conventional (standard) lobectomy between January 2002 and January 2020, whose pathologies were diagnosed with squamous cell carcinoma and adenocarcinoma, were retrospectively analyzed. The mean age of the patients was 60.5 ± 9.2, while there were 392 (82.4 %) male and 84 (17.6 %) female patients. Right-sided surgery was performed in 169 (60.4 %) patients in patients who underwent conventional lobectomy (CL), while right-sided surgery was performed in 134 (68.4 %) patients who underwent sleeve lobectomy (SL). In the CL group, 187 (66.8 %) patients were N0, 63 (22.5 %) were N1 and 30 (10.7 %) patients were N2. In the SL group, 100 (51 %) patients were N0, 78 (39.8 %) were N1 and 18 (9.2 %) were N2. Patients who underwent these two different surgical techniques; comparative analysis and propensity score matching were performed in terms of demographic characteristics, morbidity, mortality, staging and survival. Results: In the CL group, advanced T stage was found to be significant in terms of complications (p <0.0001). In the SL group, being over 60 years old (p = 0.005) and receiving neoadjuvant therapy (p = 0.012) were found to be significant in terms of complications. In Propensity score matching; there was no significant difference between CL and SL groups in terms of complication development (p = 0.605) and postoperative mortality (p = 0.723). In propensity score matching; five-year survival was 55% in the conventional group, while it was 49% in the sleeve group (p = 0.482). In the multivariate analysis; in the CL group age over 60 years (p = 0.003), FEV1 percentage below eighty-four (p = 0.019) and the presence of perineural invasion (p = 0.044) was a poor prognostic factor, while in the SL group age over 60 years (p = 0.028), presence of prognostic factor (p = 0.018) and presence of perineural invasion (p <0.0001) were found to be poor prognostic factors. Conclusion: Bronchial sleeve lobectomy is a safe procedure that can be applied in oncologically suitable cases without causing higher mortality than conventional lobectomies. Bronchial sleeve lobectomies provide better survival and can be safely preferred in non-small cell lung cancers if it is surgically and oncologically suitable.