Prospective Study on Perioperative Risks and Functional Results in Bronchial and Bronchovascular Sleeve Resections

Background: Most reports oil sleeve resections are based on a retrospective analysis over a long period of many decades. This prospective study addresses the challenging questions associated with sleeve resection. Methods: In a prospective study, 100 consecutive patients undergoing bronchial or bronchovascular sleeve resection with systematic lymph node dissection were analyzed: operative procedures, extended lymph node dissection, bronchial and vascular complications, functional results, recurrence and Survival were recorded. Results: 100 patients (male 78, female 22, age 60.0 +/- 11.9) were enrolled in this Study. A R0 resection rate of 99% Could be achieved and pneumonectomies avoided using 9 different surgical techniques. The average number of dissected lymph nodes was 30 on the right side and 33 on the left side. Morbidity and mortality were 39% and 2%, respectively. The main indication was non-small cell lung cancer (74%). The local and distant recurrence rates were 1% and 16%, respectively. The overall 5-year Survival rate was 87%. Long-term survival differed significantly between N0 and N1 status (p=0.027) and N0 and N2 status (p=0.029), but not between N1 and N2 status (p=0.754). There were no relevant differences in pre- and postoperative perfusion scans and FEV1 at 6 months after surgery. Conclusions. In the hands of experienced surgeons bronchial and bronchovascular sleeve resections are safe operations for high-risk patients. There is no statistical significance between N1 and N2 disease with regard to long-term survival. Systematic lymph node dissection does not lead to increased perioperative risk. Sleeve resections have little effect on pulmonary function. Preoperative FEV1 and lung perfusion can be achieved by 6 months after surgery.