Objective

The surgical management of main stem (involving main bronchus or artery) non-small cell lung cancer (NSCLC) remains an area of variability. Pneumonectomy carries a high risk, particularly in the ageing lung cancer population. Lung sparing procedures, despite being technically more challenging, are likely to be beneficial. We have retrospectively reviewed a single-surgeon practice in lung sparing (sleeve) techniques and their outcomes, from consultant appointment to present (1997-2015, 18 years).

Methods

1665 consecutive NSCLC resections were reviewed; 1369 major anatomical resections were performed. 319 central tumours (23%, M:F 89:44) were treated by 104 bronchial, 2 vascular and 29 double (comprising both vascular and bronchial anastomoses) sleeve-lobectomy and 157 pneumonectomy. Trends in the use of pneumonectomy, sleeve resections and mortality were analysed. Sleeve resections were predominately upper lobe (75%, 101) and occurred more on the right side (74, 55%) (Table 1).

Results

A decrease in the pneumonectomy rates (P<0.001) associated with an increase in the sleeve-resection:pneumonectomy ratio (p<0.001) was seen. Sleeve resections were associated with lower in-hospital mortality than pneumonectomy, as mirrored by a fall in overall in hospital mortality from lung cancer surgery in this 18 year period (P<0.05). A decrease in all surgery for main stem NSCLC was observed (17.7 per year, range 7-34, p<0.001), with concurrent increase in surgery for peripheral tumours.

Conclusion

An intentional policy of pneumonectomy avoidance through broncho-angioplastic techniques, in conjunction with a change in lung cancer epidemiology, has contributed to reduced mortality rates from lung cancer surgery. These techniques should form part of the specialist thoracic surgical repertoire.