Sleeve lobectomy for lung cancer

Considerable progress has been made in the field of lung cancer surgery since the first sleeve lobectomy was performed 70 years ago. Technology has advanced significantly and a multitude of lung cancer treatments and diagnostic tests is now available. These advancements have led to improved surgical treatments and understanding of this disease. Historically, pneumonectomy was considered the procedure of choice for central or locally advanced non-small cell lung cancer (NSCLC). Sleeve lobectomy was conceived only as an alternative for patients with limited cardiopulmonary reserve. However, the advantages of bronchoplastic resections for NSCLC have long been established (Thomas et al. J R Coll Surg Edinb. 1956;1:169–186; Allison et al. Ann R Coll Surg. 1954; 25:20–22; Thomas et al. Thorax. 1960;15:9–11; Weisel et al. J Thorac Cardiovasc Surg. 1979;78(6):839–849; Jensik et al. J Thorac Cardiovasc Surg. 1972;64(3):400–412. Many reliable studies have published convincing results over the years demonstrating superior outcomes over pneumonectomy when sleeve lobectomy is extended to patients with normal cardiopulmonary reserve (Gaissert et al. Thorac Cardiovasc Surg. 111(5):948–953, 1996). Not only does sleeve lobectomy surgery preserve lung function, but literature over the years has clearly shown this procedure to be associated with comparable morbidity, decreased mortality, and favorable long-term survival and enhanced quality of life (Weisel et al. J Thorac Cardiovasc Surg. 1979;78:839–849; Jensik et al. J Thorac Cardiovasc Surg. 1972;64:400–412, Ferguson et al. Ann Thorac Surg. 2003;76:1782–1788). In this review, we highlight patient selection factors and current indications for considering sleeve lobectomy. In addition, we describe our sleeve lobectomy surgical techniques and review post-operative management strategies and potential associated complications. We also discuss the long-term outcomes, recurrence, and survival rates associated with sleeve lobectomy in more recently available published series.