Objectives: When a central lung tumor extends into the pulmonary artery (PA), lobectomy with sleeve resection of the PA is a good alternative to pneumonectomy, although it’s technically more demanding. It’s a procedure in which the involved lobe is removed, along with a circular resection of the PA with end-to-end anastomosis. Sometimes a combined sleeve resection of the bronchus has to be performed. The aim of this study is to describe the surgical technique and to analyze post-operative results, recurrence and survival rates.
Methods: Between January 2000 and October 2008, 21 lobectomies with sleeve resection of the PA were performed at the University Hospitals Leuven. Arterial sleeve lobectomy was the procedure of choice, whenever technically possible. There were 17 men and 4 women, with a mean age of 63,8 years (37-76 years). In 17 cases, we performed a left upper lobe resection. Eight patients had a combined arterial and bronchial sleeve resection.
Results: In 12 patients complications occurred. The post-operative mortality (within 30 days) was 4,76%. The mean duration of hospitalization was 11,2 days (range 7-27). The mean follow-up is 34,6 months. The five-year survival rate was 56,1%. The five-year local recurrence free survival is 68,9%.
Conclusions: We conclude that arterial sleeve lobectomy can be safely performed with an acceptable mortality and morbidity. Long-term results are comparable to those of pneumonectomy. Since it’s a lungparenchyma-sparing operation, exercise tolerance and quality-of-life are often better than after pneumonectomy. For tumors with invasion of the PA, we believe this is the procedure of choice whenever technically possible.
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