Sleeve segmentectomy for non-small cell lung carcinoma

OBJECTIVE: Although sleeve segmentectomy for centrally located lung cancers was originally designed for patients unable to tolerate lobectomy, we have tried it in patients with noncompromised function as well. We evaluated the efficiency of this atypical type of bronchoplasty. METHODS: Of 202 patients for whom we performed bronchoplasty for primary non-small cell lung carcinoma, 16 underwent sleeve segmentectomy. RESULTS: Sixteen patients were classified into 4 groups according to the mode of bronchial reconstruction: type A, anastomosis between the right intermediate or left main and basal segmental bronchi with removal of the superior segment of the lower lobe (S6; n = 7); type B, anastomosis between the left main and lingular bronchi with removal of the upper division of the left upper lobe (S1+2+3; n = 3); type C, anastomosis between the left main and upper division bronchi with removal of the lingular segments (S4+5; n = 4); and type D, others (n = 2). Nine patients had pulmonary function sufficient to tolerate lobectomy. The tumors were completely resected in all patients. Combined performance of pulmonary angioplasty was carried out in 2 patients. Bronchial reconstruction was successful in all patients, with neither bronchial complications nor local recurrences. Ten patients had stage IA disease, and 6 had more advanced disease. All patients were alive, except 1 who died as a result of distant metastasis and 2 who died of noncancerous causes. Overall 3-year and 5-year survivals were 93.3% and 68.1%, respectively. CONCLUSIONS: Sleeve segmentectomy, which is technically demanding, should be considered in patients with centrally located and possibly curable early non-small cell lung cancer because the prevalence of small-sized or multiple lung tumors has been increasing and because our findings suggest that this lung-saving operation is safe and useful.