Long-term survival after sleeve lobectomy versus pneumonectomy for non-small cell lung cancer

Background
To compare short-term mortality and long-term overall survival between sleeve lobectomy and pneumonectomy for centrally located non-small cell lung cancer (NSCLC).
Methods
We retrospectively reviewed patients who had been radically resected for NSCLC by sleeve lobectomy with or without pulmonary arterioplasty at our institution between 2009 and 2023. We then propensity score-matched the patients with pneumonectomy counterparts from a national registry and compared their 30- and 90-day mortality and long-term overall survival before and after matching. The mortality was compared using independence tests and the overall survival using Kaplan-Meier estimates and the log-rank test.
Results
The study included 109 sleeve lobectomy patients and 315 pneumonectomy patients, of whom 60 patients from each group were matched. The 30- and 90-day mortality was similar between both the unmatched and matched groups (unmatched: 3.7 % vs 5.1 % and 5.5 % vs 9.2 %; matched: 5.0 % vs 6.7 % and 5.0 % vs 12 %. All p-values >0.05). The overall survival was longer in both the unmatched and matched sleeve lobectomy patients (unmatched: hazard ratio [HR] 0.52, 95 % confidence interval [CI] 0.37–0.73, p < 0.001; matched HR 0.55, 95 % CI 0.34–0.90, p = 0.018). The 5-year overall survival was 68 % and 49 % for the unmatched sleeve lobectomy and pneumonectomy patients, respectively, and 61 % and 42 % for the matched ones.
Conclusions
Sleeve lobectomy yields non-inferior short-term mortality and superior long-term overall survival compared with pneumonectomy and should be the resection of choice for centrally located NSCLC when feasible.