Bronchovascular versus bronchial sleeve resection for central lung tumors

Background. Pneumonectomy has traditionally been the treatment of choice for central lung tumors. Bronchial sleeve resections are increasingly considered as a reasonable alternative. For tumor involvement of both central airways and pulmonary artery, bronchovascular sleeve resections are possible, but considered to be technically demanding and associated with a higher perioperative risk. In addition, their role as adequate oncologic treatment for lung cancer is unclear. We have compared the early and long-term results of bronchovascular sleeve resection with those of bronchial sleeve resection and pneumonectomy. Methods. We retrospectively analyzed all patients who underwent bronchial sleeve resection (group 1, n = 104), bronchovascular sleeve resection (group 11, n = 67), and pneumonectomy (group III, n = 63) for central lung cancer in our institution. Results. The groups were comparable regarding demo-graphics and tumor, node, and metastasis (TNM) stage. Early mortality was 1.9% in group 1, 1.5% in group II, and 6.3% in group III (p = 0.19). The rate of bronchial complications was 0.96% in group 1, 0% in group II, and 7.9% in group III (p = 0.006). Five-year survival was 46.1% in group 1, 42.9% in group II, and 30.4% in group III (P = 0.16). Freedom from local recurrence of disease (5 years) was 83.8% in group 1, 84.2% in group II, and 88.7% in group III (p = 0.56). Conclusions. Bronchovascular sleeve resections are as safe as bronchial sleeve resections for the treatment of central lung cancer. Both procedures have comparable early and long-term results, which are similar to those of pneumonectomy. It appears reasonable to apply bronchovascular sleeve resections more liberally. (c) 2005 by The Society of Thoracic Surgeons.