Background: Sleeve lobectomy (SL) presents an attractive option compared to pneumonectomy (PN) for patients with central or locally advanced non-small cell lung cancer (NSCLC). This study aimed to assess the advantages of SL over PN for NSCLC via a meta-analysis. Methods: We performed a systematic review and cumulative analysis of comparative studies that reported both postoperative and survival outcomes for SL and PN. This was accomplished through a thorough search of electronic databases, including PubMed, EMBASE, and the Cochrane library, from inception to April 2023. Results: A total of 5727 patients (SL: 1945; PN: 3782) from thirty-one studies were analyzed. The meta-analysis focused on perioperative mortality, local recurrence, and overall survival. The SL group exhibited a significantly lower rate of perioperative mortality (OR = 0.43, 95% CI = 0.32–0.60, P < 0.0001). However, no significant difference was observed in local recurrence rates between SL and PN (OR = 1.25; 95% CI, 0.92 to 1.69; P = 0.16). Additionally, the survival rates at 1 year and 5 years in the SL cohort (1-year: 0.14, 95% CI: 0.12 to 0.17, p < 0.0001; 5-year: 2.15, 95% CI: 1.77 to 2.61, p < 0.0001) along with the survival in patients with pN0 or pN1 at 5 years (OR = 0.13, 95% CI 0.04 to 0.22; P = 0.006) were notably superior compared to those undergoing PN. Conclusions: Sleeve lobectomy should be regarded as a viable alternative to pneumonectomy for treating NSCLC.
Zhang L, Li M, Yin R, et al., 2015, Comparison of the Oncologic Outcomes of Anatomic Segmentectomy and Lobectomy for Early-Stage Non-Small Cell Lung Cancer. Annals of Thoracic Surgery, 99(2): 728–737.
Cusumano G, Marra A, Lococo F, et al., 2014, Is Sleeve Lobectomy Comparable in Terms of Short- and Long-Term Results With Pneumonectomy After Induction Therapy? A Multicenter Analysis. Annals of Thoracic Surgery, 98(3): 975–983.
Deslauriers J, Grégoire J, Jacques L, et al., 2004, Sleeve Lobectomy Versus Pneumonectomy for Lung Cancer: A Comparative Analysis of Survival and Sites or Recurrences. Annals of Thoracic Surgery, 77(4): 1152–1156.
Thomas C, 1956, Conservative Resection of the Bronchial Tree. Journal of the Royal College of Surgeons of Edinburgh, 1(3): 169.
Tagawa T, Iwata T, Nakajima T, et al., 2016, Evolution of a Lung-Sparing Strategy With Sleeve Lobectomy and Induction Therapy for Non-Small Cell Lung Cancer: 20-Year Experience at a Single Institution. World Journal of Surgery, 40(4): 906–912.
Lee H, Lee H, Kim K, et al., 2011, Outcomes of Sleeve Lobectomy Versus Pneumonectomy for Lung Cancer. Korean Journal of Thoracic & Cardiovascular Surgery, 44(6): 413–417.
Pan X, Tantai J, Lin L, et al., 2015, Comparison of Short and Long‐Term Results Between Sleeve Resection and Pneumonectomy in Lung Cancer Patients Over 70 Years Old: 10 Years Experience From a Single Institution in China. Thoracic Cancer, 5(6): 494–499.
Andersson S, Rauma V, Sihvo E, et al., 2015, Bronchial Sleeve Resection or Pneumonectomy for Non-Small Cell Lung Cancer: A Propensity-Matched Analysis of Long-Term Results, Survival and Quality of Life. Journal of thoracic disease, 7(10): 1742–1748.
Shi W, Wei Z, Sun H, et al., 2012, Sleeve Lobectomy Versus Pneumonectomy for Non-Small Cell Lung Cancer: A Meta-Analysis. World Journal of Surgical Oncology, 10(1): 265.
Ma Z, Dong A, Fan J, et al., 2007, 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. European Journal of Cardio-Thoracic Surgery, 32(1): 20–28.
Yoshino I, Yokoyama H, Yano T, et al., 1997, Comparison of the Surgical Results of Lobectomy With Bronchoplasty and Pneumonectomy for Lung Cancer. J Surg Oncol, 64(1): 32–35.
Okada M, Yamagishi H, Satake S, et al., 2000, Survival Related to Lymph Node Involvement in Lung Cancer After Sleeve Lobectomy Compared With Pneumonectomy. Journal of Thoracic & Cardiovascular Surgery, 119(4): 814–819.
Ghiribelli C, Voltolini L, Luzzi L, et al., 2002, Survival After Bronchoplastic Lobectomy for Non-Small Cell Lung Cancer Compared With Pneumonectomy According to Nodal Status. Journal of Cardiovascular Surgery, 43(1): 103.
Bagan P, Berna P, Pereira J, et al., 2005, Sleeve Lobectomy Versus Pneumonectomy: Tumor Characteristics and Comparative Analysis of Feasibility and Results. Annals of Thoracic Surgery, 80(6): 2046–2050.
Kim Y, Kang C, Sung S, et al., 2005, Local Control of Disease Related to Lymph Node Involvement in Non-Small Cell Lung Cancer After Sleeve Lobectomy Compared With Pneumonectomy. Annals of Thoracic Surgery, 79(4): 1153–1161.
Takeda S, Maeda H, Koma M, et al., 2006, Comparison of Surgical Results After Pneumonectomy and Sleeve Lobectomy for Non-Small Cell Lung Cancer: Trends Over Time and 20-Year Institutional Experience. European Journal of Cardio-Thoracic Surgery, 29(3): 276–280.
Parissis H, Leotsinidis M, Hughes A, et al., 2009, Comparative Analysis and Outcomes of Sleeve Resection Versus Pneumonectomy. Asian Cardiovasc Thorac Ann, 17(2): 175–182.
Park J, Yang H, Kim H, et al., 2010, Sleeve Lobectomy as an Alternative Procedure to Pneumonectomy for Non-Small Cell Lung Cancer. Journal of Thoracic Oncology, 5(4): 517–520.
Bölükbas S, Eberlein M, Schirren J, 2011, Pneumonectomy vs. Sleeve Resection for Non-Small Cell Lung Carcinoma in the Elderly: Analysis of Short-Term and Long-Term Results. Thoracic & Cardiovascular Surgeon, 59(3): 142–147.
Gómez-Caro A, Garcia S, Reguart N, et al., 2011, 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. European Journal of Cardio-Thoracic Surgery, 39(3): 352–359.
Maurizi G, D'Andrilli A, Anile M, et al., 2013, Sleeve Lobectomy Compared with Pneumonectomy After Induction Therapy for Non-Small-Cell Lung Cancer. Journal of Thoracic Oncology, 8(5): 637–643.
Berry M, Worni M, Wang X, et al., 2014, Sleeve Lobectomy for Non-Small Cell Lung Cancer with N1 Nodal Disease Does Not Compromise Survival. Annals of Thoracic Surgery, 97(1): 230–235.
Ma Q, Guo Y, Shi B, et al., 2016, For Non-Small Cell Lung Cancer with T3 (Central) Disease, Sleeve Lobectomy or Pneumonectomy? Journal of Thoracic Disease, 8(6): 1227.
Ludwig C, Stoelben E, Olschewski M, et al., 2005, Comparison of Morbidity, 30-Day Mortality, and Long-Term Survival After Pneumonectomy and Sleeve Lobectomy for Non-Small Cell Lung Carcinoma. Annals of Thoracic Surgery, 79(3): 968–973.
Stallard J, Loberg A, Dunning J, et al., 2010, Is a Sleeve Lobectomy Significantly Better than a Pneumonectomy? Interactive Cardiovascular & Thoracic Surgery, 11(5): 660–666.
Okada M, Tsubota N, Yoshimura M, et al., 1999, Extended Sleeve Lobectomy for Lung Cancer: The Avoidance of Pneumonectomy. Journal of Thoracic & Cardiovascular Surgery, 118(4): 710.
Balduyck B, Hendriks J, Lauwers P, et al., 2008, Quality of Life After Lung Cancer Surgery: A Prospective Pilot Study Comparing Bronchial Sleeve Lobectomy with Pneumonectomy. Journal of Thoracic Oncology, 3(6): 604–608.
Ferguson M, Lehman A, 2003, Sleeve Lobectomy or Pneumonectomy: Optimal Management Strategy Using Decision Analysis Techniques. Annals of Thoracic Surgery, 76(6): 1782–1788.