Sleeve Lobectomy for Non-Small Cell Lung Cancer

Sleeve lobectomy is a procedure in which the involved lobe with part of the main stembronchus is removed. The remaining lobe (s) is reimplanted on the main stembronchus. This procedure is indicated for central tumors of the lung as an altemative to pneumonectomy. It is the aim of this study to describe the technique of sleeve lobectomy and to analyse the early postoperative results and late results (survival-recurrence) after sleeve lobectomy for non-small-cell lung cancer.

Material and methods: Between 1985 and 1999, 77 sleeve lobectomies for bronchogenic carcinoma were performed at the University hospitals Leuven. The most common performed sleeve lobectomy is the right upper lobe sleeve lobectomy (67,5%). In 6 patients a combined sleeve resection of the pulmonary artery was performed. The operative mortality was 3,9%. Two patients developed a broncho-pleural fistula. The five-year survival rate was 45,6%. In 5 patients, an anastomotic suture developed which required a completion pneumonectomy in 2. Thirteen patients developed local tumor recurrence.

Conclusion: We conclude that sleeve lobectomy can be performed with an acceptable mortality and morbidity. Long term survival rate and recurrence rate are as good as after pneumonectomy. The operative mortality is lower when compared to pneumonectomy, exercise tolerance and quality of life are much better after sleeve lobectomy compared to pneumonectomy. For central tumours we believe that sleeve resection is the procedure of choice.     

Favorable results after sleeve lobectomy or bronchoplasty for bronchial malignancies

Background. Sleeve lobectomy and bronchoplasty are established alternatives to pneumonectomy for bronchial malignancies involving a main bronchus. However, potential bronchial anastomotic complications have deterred the general application of these types of resection. Some reports have contained a mixture of non-small cell lung cancer (NSCLC) and tumors of low-grade malignancy, making it difficult to assess the long-term results of these procedures as an alternative to pneumonectomy for lung cancer.

Methods. We retrospectively reviewed our experience with sleeve lobectomy and bronchoplasty for bronchial malignancies from January 1988 to September 1998 separating NSCLC (n = 58) from tumors of low-grade malignancy (n = 19). We compared the overall results between sleeve lobectomy and pneumonectomy (n = 142) performed for NSCLC over the same time interval.

Results. For NSCLC, after sleeve lobectomy, the operative mortality was 5.2% (3 of 58 patients) and the overall 5-year actuarial survival was 37.5%. After pneumonectomy, the operative mortality was 4.9% (7 of 142 patients) and the overall 5-year actuarial survival was 35.8%. For tumors with low-grade malignancy, there was no operative mortality after sleeve lobectomy or bronchoplasty and the 5-year actuarial survival was 100%. Major bronchial anastomotic complications occurred in 3 patients among the 77 patients who underwent sleeve resection.

Conclusions. Sleeve resection can be performed with a low risk of bronchial anastomotic complication. The long-term survival after sleeve resection for NSCLC is similar to pneumonectomy. Excellent results are obtained after sleeve resection for low-grade malignancies.     

Comparison of surgical results after pneumonectomy and sleeve lobectomy for non-small cell lung cancer: trends over time and 20-year institutional experience.

OBJECTIVE: Sleeve lobectomy is a lung-saving procedure for central tumors for which the alternative is pneumonectomy. The purpose of this study was to report the clinical characteristics, operative results, survival, and late outcomes over 20 years in patients who underwent sleeve lobectomy and pneumonectomy at our institution. METHODS: There were 62 patients who underwent sleeve lobectomy (SL group) and 110 who underwent pneumonectomy (PN group). Comparisons of the demographics, morbidity, and survivals between the groups were performed by unpaired t-test, chi(2)-test, and log-rank test. RESULTS: Patients who underwent a pneumonectomy showed a significantly advanced pathological stage, and a larger tumor size than those who received a sleeve lobectomy, whereas there were no significant differences in histology, ratio of combined resection and induction therapy, or total morbidity. There were three in-hospital deaths (4.8%) in the SL group and four (3.6%) in the PN group. Local relapse and distant recurrence incidence were similar between the two groups. The 5-year-survival rates of the SL and PN groups were 54% and 33%, respectively (p<0.0001). However, there were no differences in 5-year survivals in patients with pathological stage I/II (SL, 59% vs PN, 63%) and those who received induction therapy (SL, 22% vs PN, 52%) between the groups. CONCLUSIONS: Both pneumonectomy and sleeve lobectomy were performed with an acceptable risk of operative mortality and satisfactory 5-year survival rate. The indication of pneumonectomy is aimed to perform a curative resection for locally advanced lung cancer, particularly after induction therapy that is otherwise unresectable, and the selected patients will likely benefit from a complete resection.     

Surgical outcome of tracheobronchial reconstruction for lung cancer

We retrospectively evaluated the surgical outcome after sleeve lobectomy and pneumonectomy with tracheobronchial reconstruction for lung cancer. From 1993 to 2008, 46 patients with primary lung cancer underwent these surgical procedures. Seventeen patients (37%) received induction therapy, 15 received chemotherapy, while chemoradiotherapy or radiotherapy alone were received by one patient each. Sleeve lobectomy without carinal resection was performed in 41 patients. Carinal resection with 2 sleeve pneumonectomies was performed in 5 patients. There were no operative deaths. Bronchopleural fistula occurred in one patient, who required completion pneumonectomy. One patient presented local mucosal necrosis in the anastomotic site and was managed conservatively. Two patients had bronchial strictures as late complications and successfully dilated by a balloon using bronchoscopy. Overall 5-year and 10-year survival rates were 54% and 48%, respectively. No recurrence developed at any anastomotic site. The results showed that sleeve lobectomy and pneumonectomy with tracheobronchial reconstruction can be performed with low mortality and bronchial anastomotic complication rates. As well, local control of the tumor was satisfactory.     

Sleeve lobectomy for bronchogenic cancers: factors affecting survival

BACKGROUND: Sleeve lobectomy is a parenchyma-sparing procedure that is particularly valuable in patients with cardiac or pulmonary contraindications to pneumonectomy. The purpose of this study is to report our experience with sleeve lobectomy for bronchogenic cancer and to investigate factors associated with long-term survival. METHODS: Between January 1981 and June 2001, 169 patients underwent sleeve lobectomy for non-small-cell lung cancer (n = 139) or carcinoid tumor (n = 30), including 61 with a preoperative contraindication to pneumonectomy. Mean age was 59 +/- 14 years (range, 19 to 82 years). Vascular sleeve resection was performed in 11 patients. The remaining bronchial stump contained microscopic disease in 7 patients. RESULTS: Major bronchial anastomotic complications occurred in 6 (3.6%) patients: one was fatal postoperatively, three required reoperation, and two were managed conservatively. In the non-small-cell lung cancer group, operative mortality was 2.9% (4 of 139), and overall 5-year and 10-year survival rates were 52% and 28%, respectively. Six patients experienced local recurrence after complete resection. By multivariate analysis, two factors significantly and independently influenced survival: nodal status (N0 or N1 versus N2; p = 0.01) and microscopic invasion of the bronchial stump (p = 0.02). In the carcinoid tumor group, there were no operative deaths, and overall 5-year and 10-year survival rates were 100% and 92%, respectively. CONCLUSIONS: Sleeve lobectomy achieves local tumor control and is associated with low mortality and bronchial anastomotic complication rates. Long-term survival is excellent for carcinoid tumors. For patients with non-small-cell lung cancer, N2 disease or incomplete resection is associated with a worse prognosis; outcome is not affected by presence of a preoperative contraindication to pneumonectomy.     

Iterative surgical resections for local recurrent and second primary bronchogenic carcinoma.

OBJECTIVE: To report our experience with repeated pulmonary resection in patients with local recurrent and second primary bronchogenic carcinoma, to assess operative mortality and late outcome. METHODS: The medical records of all patients who underwent a second lung resection for local recurrent and second primary bronchogenic carcinoma from 1978 through 1998 were reviewed. RESULTS: There were 27 patients. They constituted 2.5% of 1059 patients who had undergone lung resection for bronchogenic carcinoma in the same period. Twelve patients (1.1%) (group 1) had a local recurrence that developed at a median interval of 24 months (range 4-83).The first pulmonary resection was lobectomy in ten patients and segmentectomy in two. The second operation consisted of completion pneumonectomy in ten cases, completion lobectomy in one and wedge resection of the right lower lobe after a right upper lobectomy in one. The other 15 patients (1.4%) (group 2) had a new primary lung cancer that developed at a median interval of 45 months (range 21-188).The first pulmonary resection was lobectomy in 12 patients, bilobectomy in one and pneumonectomy in two. The second pulmonary resection was controlateral lobectomy in seven patients, controlateral sleeve lobectomy in two, controlateral pneumonectomy in 1, controlateral wedge resection in four and completion pneumonectomy in one. Overall hospital mortality was 7.4%, including one intraoperative and one postoperative death in group 1 and 2, respectively. Five-year survival after the second operation was 15.5 and 43% with a median survival of 26 and 49 months in groups 1 and 2, respectively (P=ns). CONCLUSIONS: Long-term results justify complete work-up of patients with local recurrent and second primary bronchogenic carcinoma. Treatment should be surgical, if there is no evidence of distant metastasis and the patients are in good health. Early detection of second lesions is possible with an aggressive follow-up conducted maximally at 4 months intervals for the first 2 years and 6 months intervals thereafter throughout life.     

Sleeve lobectomy in lung cancer

Sleeve lobectomy for lung cancer is now commonly performed around the world for central lung cancers that are anatomically suitable regardless of lung function. The morbidity and mortality are low, especially when compared with pneumonectomy. Bronchial complications are quite low. Local control seems to be at least as good as that obtained with pneumonectomy. Survival in most series is better with sleeve lobectomy than with pneumonectomy. Although there is still controversy with the use of sleeve lobectomy in patients with N1 disease, several recent series suggest better survival compared with pneumonectomy. Sleeve lobectomy can be safely performed after induction therapy. Quality of life is better with sleeve lobectomy compared with pneumonectomy.     

Results in 104 patients undergoing bronchoplastic procedures for bronchial lesions

Bronchoplastic procedures were used in 104 patients with various bronchial disorders. Ten had benign lesions and 94, malignant tumors. The principal operative procedures were sleeve lobectomy and sleeve pneumonectomy for bronchogenic carcinoma, but 11 limited bronchial resections were performed in patients with benign lesions, minute bronchogenic carcinomas, and low-grade malignant tumors. Of the 94 patients with malignant tumors, 79 underwent a bronchoplastic procedure without carinal resection (sleeve lobectomy in 75 and limited bronchial resection in 4), and there was one operative death (1.3%). The overall 5-year survival rate for the patients with bronchogenic carcinoma in this group was 45% and that for patients undergoing curative resection, 57% (survival of patients in stages I, II, and IIIA was 79%, 55%, and 30%, respectively). A bronchoplastic procedure with carinal resection was performed in 15 patients. Twelve in this group underwent sleeve pneumonectomy. There were two operative deaths, and 1 patient has survived for longer than 4 years. Two patients with low-grade malignant tumors underwent carinal resection without lung resection and are still alive. We believe that bronchoplasty is a safe and valuable procedure and that limited bronchial resection appears to be the procedure of choice for localized bronchial lesions.     

Bronchoplastic procedures for bronchial carcinoma

In a 22-year period from 1962 to 1984, 51 patients with malignant lung disease had a sleeve resection performed. In 33% of the patients, pneumonectomy was contraindicated because of limited lung function. The operative mortality was 8%. Six per cent of the patients developed complications after the operation. The 5-year survival of the total group of patients was 30%. Patients with lesions classified as stage 1 and stage 2 had the best prognosis, with a 5- and 10-year survival of 43.5% and 27%, respectively. In patients classified as stage 3 and stage 4, the 5- and 10-year survival was 20%. A postoperative measurement of regional ventilation and perfusion indicated that the function of the remaining lung was presumably undisturbed by the operation. Also, the vital capacity and FEV 1 were only minimally reduced as a result of the operation. The amount of functional lung tissue spared by the operation compared to pneumonectomy was estimated to 39%. Because of these functional results and the promising 5-year survival figures, we suggest that sleeve lobectomy should be the operation of choice for tumors localized to the upper lobe orifice involving the main bronchus.     

Survival after bronchoplastic lobectomy for non small cell lung cancer compared with pneumonectomy according to nodal status.

BACKGROUND: In this retrospective study we have compared the results after sleeve lobectomy and pneumonectomy performed for non small cell lung cancer in the period January 1990-December 1995 at the Thoracic Surgery Unit, University Hospital of Siena. Follow-up was updated until December 2000. METHODS: In that period, 38 patients underwent sleeve lobectomy and 127 underwent pneumonectomy. The bronchoplasty was a full sleeve in 30 patients and a bronchial wedge resection in eight. Systemic nodal dissection was undertaken routinely. RESULTS: The 30-day postoperative mortality was 5.2% (2/38) in the sleeve lobectomy group and 3.9% (5/127) in the pneumonectomy group. Postoperative complications occurred in 23.6% of patients in the sleeve lobectomy group and in 23.2% of those in the pneumonectomy group. Local recurrences occurred in 5.2% of patients in the sleeve lobectomy group and in 4.8% of those in the pneumonectomy group. The overall 5-year survival for the sleeve lobectomy group was 38% whereas that for the pneumonectomy group was 25% (p=0.03). Regarding lymph-node involvement, in the sleeve lobectomy group, the 5-year survival for N0, N1 and N2 was 62.5, 17.5 and 12.5%, respectively. CONCLUSIONS: Our data confirm that sleeve lobectomy, when performed in selected patients with non small cell lung cancer, provides at least similar overall long term survival to that seen after pneumonectomy. Long term result are chiefly related to nodal stage with a significantly lower survival for patients with nodal involvement. As most patients with nodal involvement die from distant metastases, adjuvant treatment, instead of type of resection, would play a major role in prolonging survival.     

Morbidity, mortality, and long-term survival after sleeve lobectomy for non-small cell lung cancer.

OBJECTIVE: Sleeve lobectomy is a widely accepted procedure for central tumors for which the alternative is pneumonectomy. The purpose of this study is to assess operative mortality, morbidity, and long-term results of sleeve lobectomies performed for non-small cell lung carcinoma (NSCLC). METHODS: A retrospective review of 218 patients who underwent sleeve lobectomy for NSCLC between 1981 and 2005 was undertaken. There were 186 (85%) men and 32 women with a mean age of 61.9 years (range, 19-82 years). Eighty patients (36.6%) had a preoperative contraindication to pneumonectomy. Right upper lobectomy was the most common operation (45.4%). Vascular sleeve resection was performed in 28 patients (12.8%) and was commonly associated with left upper lobectomy (n=20; 9.1%; p=0.0001). The histologic type was predominantly squamous cell carcinoma (n=164; 75%), followed by adenocarcinoma (n=46; 21%). Resection was incomplete in nine (4.1%) patients. RESULTS: There were nine operative deaths; the operative mortality and the morbidity rates were 4.1% and 22.9%, respectively. A total of 14 (6.4%) patients presented with bronchial anastomotic complications: two were fatal postoperatively, seven patients required reoperation, three required a stent insertion, and two were managed conservatively. Multivariate analysis showed that compromised patients (p=0.001), current smoking (p=0.01), right sided resections (p=0.003), bilobectomy (p=0.03), squamous cell carcinoma (p=0.03), and presence of N1 or N2 disease (p=0.01) were risk factors for mortality and morbidity. Follow-up was complete in 208 patients (95.4%). Overall 5-year and 10-year survival rates were 53% and 28.6%, respectively. After complete resection, recurrence was local in 10 patients, mediastinal in 20, and distant in 25. By multivariate analysis, two factors significantly and independently influenced survival: nodal status (N0-N1 vs N2; p=0.01) and the stage of the lung cancer (stage I-II vs III, p=0.02). CONCLUSIONS: For patients with NSCLC, sleeve lobectomy achieves local tumor control, even in patients with preoperative contraindication to pneumonectomy and is associated with low mortality and bronchial anastomotic complication rates. Postoperative complications are higher in compromised patients, smokers, N disease, right sided resections, bilobectomies, and squamous cell cancers. The presence of N2 disease and stage III significantly worsen the prognosis.     

Survival and prognostic factors in patients undergoing parenchymal saving bronchoplastic operation for primary lung cancer: a series of 110 consecutive cases.

OBJECTIVE: The purpose of this study was to report our experience concerning bronchial sleeve lobectomy for treating bronchogenic cancer. METHOD: From 1980 to 1994, 110 patients underwent bronchial sleeve lobectomy for bronchogenic cancer. In 45 patients, preoperative investigations contraindicated pneumonectomy, whereas in 65 other patients, sleeve resection was performed without functional necessity. The most common procedures were sleeve lobectomy of the right upper lobe (64%), and of the left upper lobe (21%). Sixteen patients (15%) underwent additional arterial vascular resection. Seven patients had microscopic invasion of the bronchial margin without the possibility of further resection in six with regard to their limited respiratory function. Tumors were staged as follow: 32 stage IB (all T2 N0), 57 stage IIB (57T2 N1), and 17 stage IIIA (eight, T3N1; nine, T2N2), whereas four patients had an in situ cancer (four stage 0). RESULTS: Operative mortality was 2.75%. The 5- and 10-year actuarial survival rates were, respectively, 39 and 22% for the entire group. The 5-year actuarial survival rates were, 60% in stage IB, 30% in stage IIB, and 27% in stage IIIA. Four factors significantly influenced survival (P<0.05): nodal stage, arterial resection, invasion of the bronchial stump and poor functional respiratory status contraindicating pneumonectomy. CONCLUSIONS: In our experience, sleeve resection for stage I provides comparable survival to that of standard resection at equal stage. However, in patients with pathologically N1 disease, who can tolerate a pneumonectomy, a randomized study is mandatory to confirm that sleeve lobectomy can be performed without the risk of decreasing long-term survival. In our study, patients who required an associated vascular resection demonstrated a poor survival.     

The place for bilobectomy in bronchogenic carcinoma.

From 1978 to 1988, 148 bilobectomies (21 upper and middle and 127 lower and middle) were performed for bronchogenic carcinoma. A conservative procedure was mandatory in 29 patients in whom a pneumonectomy was not functionally feasible while bilobectomy was deliberately performed in 119 patients with near normal lung function. Overall mortality was 6% compared to 4% and 3%, respectively, following pneumonectomies and lobectomies. Preoperative functional status did not significantly influence mortality. The complication rate was 55%. The incidence of bronchopleural fistula electively observed after lower and middle lobe resection was significantly higher (11%) compared to 4% after pneumonectomy and 1.4% after lobectomy (P less than 0.01). The overall 5-year survival was 43% and was similar to that observed at comparable TNM stage after other pulmonary resections. Residual right pulmonary function demonstrated by perfusion isotopic scan was 24% +/- 10 in 21 long-term survivors. These results indicate that bilobectomy can reasonably be considered in patients requiring more than a lobectomy but in whom lung conservation is mandatory despite a significant increase in morbidity. The risk appears justifiable regarding late survival results and functional benefit of the remaining right lobe.     

Bronchial and bronchovascular sleeve resection for treatment of central lung tumors

BACKGROUND: To improve postoperative pulmonary reserve, we have employed parenchyma-sparing resections for central lung tumors irrespective of pulmonary function. The results of lobectomy, pneumonectomy, and sleeve resection were analyzed retrospectively. METHODS: From October 1995 to June 1999, 422 typical lung resections were performed for lung cancer. Of these, 301 were lobectomies (group I), 81 were sleeve resections (group II), and 40 were pneumonectomies (group III). RESULTS: Operative mortality was 2% in group I, 1.2% in group II, and 7.5% in group III (group I and II vs. group III, p<0.03). Mean time of intubation was 1.0+/-4.1 days in group I, 0.9+/-1.3 days in group II, and 3.6+/-11.2 days in group III (groups I and II vs. group III, p<0.01). The incidence of bronchial complications was 1.3% in group I, none in group II, and 7.5% in group III (group I and II vs group III, p<0.001). After 2 years, survival was 64% in group I, 61.9% in group II, and 56.1% in group III (p = NS). Freedom from local disease recurrence was 92.1% in group I, 95.7% in group II, and 90.9% in group III after 2 years (p = NS). CONCLUSIONS: Sleeve resection is a useful surgical option for the treatment of central lung tumors, thus avoiding pneumonectomy with its associated risks. Morbidity, early mortality, long-term survival, and recurrence of disease after sleeve resection are similar to those seen after lobectomy.     

Bronchusmanschettenresektion

Sleeve lobectomy is an established surgical procedure in patients with lung cancer. Usually the only surgical alternative would be a pneumonectomy. This article describes the perioperative risks and functional results in patients after sleeve lobectomy compared to pneumonectomy and typical lobectomy. There were only minor differences with respect to postoperative morbidity comparing the different procedures but the mortality rate was higher following pneumonectomy. Bronchopleural fistula rates were also similar comparing lobectomy and sleeve lobectomy but elevated following pneumonectomy. Bronchovascular fistulas after sleeve lobectomy are potentially life-threatening. Postoperative pulmonary function tests showed similar values for lobectomy and sleeve lobectomy patients and were considerably better than following pneumonectomy. Whenever possible sleeve lobectomy should take preference over pneumonectomy.     

History and current status of bronchoplastic surgery for lung cancer

Sleeve lobectomy for carcinoma of the lung was first described as a compromised operation for patients whose pulmonary reserve was considered inadequate to permit pneumonectomy. Since then, many authors have suggested that bronchoplasties may provide as good if not better results than pneumonectomy in selected cases of primary carcinoma of the lung involving the proximal bronchial tree. In all reported series, lesions in the hilum of the right upper lobe are the commonest indication for sleeve lobectomy, although all lobes and segments of the lungs may on occasion be involved with tumors that are amenable to some form of lung-sparing bronchoplastic procedure. As a general statement, bronchoplasties should be considered in any case of lung cancer that can be completely resected by these techniques although some controversy persists about the application of these procedures in patients with N₁ or N₂ disease. Published reports document a 30-day operative mortality of 0%–5%. Complications peculiar to sleeve lobectomy are an increased incidence of retained secretions, bronchovascular fistulas, and a potential for an increased incidence of local recurrence. Most major reports document a 5-year survival of 40%–50% and functional results that are significantly better than those obtained following pneumonectomy. This review was submitted at the inviation of the editorial committee.     

Pulmonary resection using a total endoscopic robotic video-assisted approach

We have developed a robotic video-assisted thoracoscopic technique (RVATS) for lung resection that could encourage broader use of minimally invasive lobectomy. During December 2006 to September 2010, RVATS was performed in 200 consecutive patients (90 women, 110 men) with the da Vinci Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA). Pulmonary resection was performed through ports without the need for a utility incision. Data on patients' perioperative results were collected retrospectively. Robotic video-assisted pulmonary resection was accomplished in 197 of 200 patients. A total of 154 patients underwent lobectomy; 4 patients required bilobectomy, and 35 patients underwent segmentectomy. Three patients underwent a sleeve lobectomy, and 3 patients had an en-bloc resection with lobectomy. One patient received a left pneumonectomy. Three patients required conversion to a thoracotomy. The median operative time was 90 minutes. The median length of hospital stay was 3 days. 60-day mortality and morbidity was 2% and 26%, respectively. RVATS lung resection is technically feasible, safe, and results indicate the procedure is associated with reduced length of stay, low morbidity, and mortality.     

支气管袖式肺叶切除肺动脉成形术治疗中心型肺癌

目的 总结支气管袖式肺叶切除、肺动脉成形术治疗中心型肺癌的临床经验.方法 回顾分析1989年5月至2009年5月收治的52例中心型肺癌患者,其中38例行支气管环状切除成形及支气管袖式肺叶切除术;12例行支气管肺动脉双袖式肺叶切除术;2例行气管隆突及半隆突切除重建合并肺叶切除术.结果 本组术后死亡1例,发生手术并发症5例...     

Right pneumonectomy or sleeve lobectomy in the treatment of bronchogenic carcinoma

Although surgical resection is the only satisfactory treatment for lung cancer, its contribution to the total salvage of patients is small. Palliation of the majority of patients seems much more important than cure of a small minority. Therefore, the most economical procedure possible should be used. The high mortality and functional sacrifice of right pneumonectomy make this attitude mandatory for right-sided hilar carcinoma. Even a “forced” sleeve resection in the presence of proved lymphoglandular invasion of the right hilum may produce worthwhile palliation.The results of 21 sleeve lobectomies and 30 right pneumonectomies are compared. Operative mortality was distinctly lower and the mean survival time longer in the sleeve resection group. The quality of survival was better by far after sleeve lobectomy.     

Extended sleeve lobectomy for interlobar lymph node metastasis invading the bronchus from peripheral lung cancer

Although extended sleeve lobectomy has been used as an alternative to pneumonectomy for the treatment of centrally located lung cancer, the validity of this surgical procedure is unclear in patients with peripheral lung cancer with interlobar lymph node metastasis invading the bronchus. We herein report four patients with peripheral lung cancer in the left lower lobe who underwent extended sleeve lobectomy consequent to interlobar lymph node metastasis. The tumor and metastasized lymph node was extirpated en bloc with division of the main bronchus and upper division bronchus, and those bronchi were anastomosed using the telescope method. All patients were doing well without recurrence. Extended sleeve lobectomy may be applicable to patients with peripheral lung cancer with interlobar lymph node metastasis invading the bronchus to avoid pneumonectomy.