Predictors of mortality in bronchial sleeve resections for non-small cell lung cancer

Bronchial sleeve resections are standard procedures in thoracic surgery. We performed a retrospective analysis to find risk factors for mortality after sleeve resection for NSCLC.

Methods: From 1991 to 2000, 100 patients underwent sleeve resection for NSCLC. 61 lobectomies, 18 bilobectomies, 4 upper lobectomies with carinal resection, 15 pneumonectomies, and 2 other procedures were performed for stage 0 (n=2), I (21), II (39), 3A (22), 3B (12), 4 (3). Mean age was 61. Minimum follow-up was 2yrs. Uni-/multivariate analyses were performed for 96 procedures (reoperations excluded). Variables investigated were histology, stage, procedure, type of resection, angioplasty, adjuvant therapy and respiratory risk.

Results: 3- and 5-yr survival was 52% and 39%, respectively. Median survival was 36.7 months. 3- and 5-yr for N0 (n=26) was 72% and 54%; for N1 (46), 54% and 43%; and for N2 (23), 30% and 17%, respectively (p=0.018). Patients with chronic obstructive pulmonary disease (FEV1<60%) had a 5-yr survival of 21% vs. 45% (FEV1>=60%) (p=0.027). Multivariate analysis showed nodal status, respiratory risk and procedure to be significant predictors for survival. Thirty percent of patients died of recurrent tumor or distant metastases.

Conclusions: Results after bronchial sleeve lobectomies are influenced by nodal status and preoperative lung function. Sleeve pneumonectomies and bilobectomies have a poorer outcome. The most common cause of death is progression of disease.