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Staging and management of lung cancer: Sleeve resection

World Journal of Surgery volume 17, pages 712–718 (1993)Cite this article

Abstract

Sleeve lobectomy is a lung-saving procedure usually indicated for central tumors for which the alternative is a pneumonectomy. It preserves normal lung tissue and may enable pulmonary resection to be done in selected patients with inadequate cardiac or pulmonary reserve. One experience extends from January 1972 to December 1991, during which time 142 patients underwent a variety of sleeve resections for bronchogenic neoplasms. The majority of operations were upper-lobe sleeve resections (N=110) and most procedures were considered complete and potentially curative (87%). There were three postoperative deaths (surgical mortality of 2.5%) and prolonged atelectasis was the most common major complication (N=9). Follow-up was complete for the 139 survivors (mean follow-up time of 2,149 days) and overall survival was 46% at 5 years and 33% at 10 years. Five- and 10-year survivals for patients with stage I disease were 63% and 52%, respectively, while only 14% of patients with stage III disease survived 5 years. Local recurrences occurred in 23% of patients but when the resection had been complete, this incidence was 17% (21/124). These results indicate that sleeve resection is an adequate cancer operation for both compromised and uncompromised patients. Operative mortality, survival, and incidence of local recurrence are not different than what is seen after more conventional procedures.

Résumé

La lobectomie “en manchonnage” est une méthode de résection indiquée en cas tumeur centrale pour laquelle la seule alternative aurait été une pneumonectomie. Cette intervention conserve du tissu pulmonaire normal et convient aux patients ayant une réserve cardiaque ou pulmonaire limite. Notre expérience s'étend de Janvier 1972 à Décembre 1991, période durant laquelle 142 patients ont eu une résection en “manchonnage” pour cancers bronchopulmonaires divers. La majorité des interventions étaient des résections du lobe supérieur (n = 110) et la plupart des interventions ont été classées comme curatives ou potentiellement curatives (87%). Il y a eu 3 morts postopératoires (mortalité chirurgicale de 2.5%) et une atélectasie prolongée a été la complication la plus fréquente (n = 9). Le suivi a été complet pour les 139 survivants (suivi moyen de 2149 jours); la survie globale a été de 46% à 5 ans et 33% à 10 ans. La survie à 5 et à 10 ans chez les patients ayant une maladie stade I a été respectivement de 63% et 42% alors que seulement 14% des patients stade III ont survecu 5 ans. Les récidives locales sont survenues chez 23% des patients mais lorsque la résection était complète, cette incidence a été de 17% (21/124). Ces résultats indiquent que la résection “en manchonnage” est une intervention suffisante pour la plupart des patients. La mortalité opératoire, la survie et l'incidence des récidives locales ne sont pas différentes de celles observées avec des procédés conventionnels.

Resumen

La lobectomía con resección en manguito es un procedimiento que preserva tejido pulmonar y que usualmente está indicado para tumores de ubicación central para los cuales la alternativa es la neumonectomía. Al conservar parenquima pulmonar, puede lograrse la resección en pacientes seleccionados con reserva funcional cardiopulmonar inadecuada. Nuestra experiencia se extiende entre enero de 1972 hasta diciembre de 1991, periodo durante el cual 142 pacientes con tumores broncogénicos fueron sometidos a una variedad de resecciones en manguito. La mayoría fueron resecciones en manguito del bronquio del lóbulo superior (N = 110) y casi todos fueron considerados como completas y potencialemte curativas (87%). Se registraron tres muertes postoperatoria (mortalidad quirúrigica de 2.5%); la atelectasis prolongada constituyó la complicación más común (N = 9). El seguimiento fue completo para los 139 sobrevivientes (promedio de seguimiento de 2.149 días) y la tasa global de sobrevida fue de 46% a 5 años y de 33% a 10 años. La sobrevida a 5 y 10 años para los pacientes en estados I fue 63% y 52%, respectivamente, mientras sólo 14% de los pacientes con estado II sobrevivieron 5 años. Se observó recurencia local en 23% de los pacientes, pero cuando la resección fue completa, la tasa fue de 17% (21/124). Estos resultados indican que la resección en manguito es una operación oncológica adecuada tanto para los pacientes en buen estado general como para los que tienen compromiso funcional. La mortalidad operatoria, las tasas de sobrevida y de recurrencia local no son diferentes de las que se observan luego de procedimientos más convencionales.

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Affiliations

  1. Department of Surgery at Laval University, Ste-Foy, Quebec, Canada

    Jean Deslauriers M.D., F.R.C.S.(C)

  2. Thoracic Surgery Division, Le Centre de Pneumologie de Laval, 2725 Chemin Ste-Foy, G1V 4G5, Ste-Foy, Quebec, Canada

    Jean Deslauriers M.D., F.R.C.S.(C)

  3. Division of Thoracic Surgery, Le Centre de Pneumologie de Laval, 2725 Chemin de Ste-Foy, G1V 4G5, Ste-Foy, Quebec, Canada

    Reza John Mehran M.D.C.M., M.Sc, F.R.C.S.(C)

  4. Laval University Epidemiology Research Group, Canada

    Chantai Guimont M.Sc. & Jacques Brisson M.D., D.Sc.

Authors
  1. Jean Deslauriers M.D., F.R.C.S.(C)
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  2. Reza John Mehran M.D.C.M., M.Sc, F.R.C.S.(C)
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  3. Chantai Guimont M.Sc.
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  4. Jacques Brisson M.D., D.Sc.
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Deslauriers, J., Mehran, R.J., Guimont, C. et al. Staging and management of lung cancer: Sleeve resection. World J. Surg. 17, 712–718 (1993). https://doi.org/10.1007/BF01659080

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  • DOI: https://doi.org/10.1007/BF01659080

Keywords

  • Local Recurrence
  • Como
  • Cual
  • Pulmonary Resection
  • Normal Lung Tissue