Chirurgie bij patiënten met centraal gelegen niet-kleincellig longcarcinoom: longparenchymsparende ingreep versus pneumonectomie

To examine if lung-parenchymal sparing resection ('sleeve' resection) is a safe and oncologically responsible alternative to pneumonectomy in patients with central tumours. Further, to evaluate in how far this technique is being used in the Netherlands. Retrospective cohort study. Patients undergoing either lung-parenchymal sparing procedure or pneumonectomy for centrally situated non-small cell lung carcinoma (NSCLC) between January 1995 and January 2010 were included. Early mortality, perioperative complications, survival and disease-free survival in both groups were compared. Survival was calculated using the Kaplan-Meier method. A total 78 patients underwent sleeve resection and 89 pneumonectomy. Early mortality (during admission or within 30 days of operation) in the sleeve-resection group was 1.3% (1 patient), and 9.0% (8) (p = 0.038) in the pneumonectomy group. In the sleeve-resection group 6.4% (5) developed a bronchopleural fistula; in the pneumonectomy group this was 4.5% (4) (p=0.735). Median survival in the sleeve-resection group was 90 months, and 1- and 5-year-survival were 88 (SD: 4) and 61% (SD: 6), respectively. Median survival in the pneumonectomy group was 17 months, with a 1- and 5-year survival of 63 (SD: 5) and 24% (SD: 5), respectively. The difference in survival was significant (p <0.001; hazard ratio: 3.27; 95% CI: 2.11-5.08). The effect of TNM stage was not statistically significant in addition to operation (p = 0.079) and TNM stage was not a clear confounder: even after analysis the hazard ratio was 2.74. In the sleeve-resection group, after 5 years disease-free survival was 62% (SD: 7). In the pneumonectomy group, this was 34% (SD: 7) (p = 0.05). Patients with centrally-situated NSCLC who undergo a lung-parenchymal sparing procedure have lower mortality and better survival than patients who undergo pneumonectomy