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PARENCHYMA-SPARING SURGERY FOR PROXIMAL NSCLC: SLEEVE RESECTIONS RESULT IN EQUIVALENT SURVIVAL AND BETTER PERFORMANCE THAN PNEUMONECTOMIES

Eastern Virginia Medical School, Norfolk, VA

PURPOSE: The perioperative risk after pneumonectomy is high (8-12%) and dramatically decreases a patient’s quality of life, so that parenchyma-sparing procedures are needed. Airway sleeve resections have been described for several decades, but remain rarely done. Arterial sleeve resections are even rarer, and done in only a few centers. We have used airway and arterial sleeve resections commonly, and report a prospective comparison of perioperative complications and survival among airway sleeve resections, arterial sleeve resections, and pneumonectomies.

METHODS: All patients with NSCLC underwent surgical staging prior to resection. At resection patients underwent parenchymal sparing procedures if possible. All patients were resected with negative margins.Survival was compared using nonparametric distribution analysis while differences among means were compared using Student’s t test. Differences in proportions were compared using chi-square. p values <0.05 were considered significant.

RESULTS: Eighty-six patients underwent sleeve resections and 74 patients underwent pneumonectomy. The pneumonectomy patients were younger (58.4 vs 62.7 years) but were otherwise similar. Pneumonectomy patients spent more days in the ICU (3.5 vs. 1.2, p=0.046) but had similar lengths of stay. No difference in overall survival nor in comparisons between node-negative resections (see graph) were found.

CONCLUSION: Sleeve Resections give equivalent survival compared to pneumonectomies and allow preservation of pulmonary parenchyma. With postoperative chemotherapy becoming standard treatment after most hilar resections, preserving lung function, and thus ability to tolerate adjuvant chemotherapy, is more important.

CLINICAL IMPLICATIONS: Sleeve resections allow preservation of lung function and result in equivalent survival.

1-year 2-years 3-years 4-years 5-years Sleeves 85.70% 72.20% 57.10% 62.50% 50% Pneumonectomies 93.80% 78.60% 76.90% 53.80% 50%

DISCLOSURE: Gary Hochheiser, None.