Importance of bronchial and bronchovascular sleeve resections for treatment of non-small cell lung cancer

Background. Centrally located non-small cell lung cancer (NSCLC) can be resected by either pneumonectomy or parenchyma-sparing sleeve resection. The questions of local radicalness, significance in advanced nodal disease and the functional outcome after sleeve resection are still under discussion. Objective. The aim of this study was an evidence-based systematic review of the current status and comparison of both resection techniques in the treatment of centrally located NSCLC. Material and methods. A systematic literature search was performed in Pubmed, Medline, current guidelines and by manual searching. Relevant publications from the last 15 years were analyzed and the results are summarized in a structured review. Results and discussion. Sleeve resection is performed less often than pneumonectomy. Bronchovascular sleeve resection can be performed with low morbidity and mortality. Theses methods do not have a worse prognosis compared with isolated bronchial sleeve resection. The weighted average for local recurrence is 16.1% for sleeve resection and 27.8% for pneumonectomy. Even in the case of multilevel N1/N2 disease the local recurrence rate is low. In nodal negative and nodal positive disease, pneumonectomy does not result in better long-term survival. Sleeve resection can safely be performed in older patients (>70 years). Quality of life is better after sleeve resection than after pneumonectomy. Lung perfusion and forced expiratory volume per second 6 months after sleeve resection are similar to preoperative values. The loss of function after sleeve resection is comparable to lobectomy. Whenever technically and ontologically reasonable, sleeve resection should be preferred.