Sleeve Lobectomy Or Pneumonectomy For Non-Small Cell Lung Cancer: A Systemic Review

Objective To systemically analyze the clinical value of sleeve lobectomy (SL) and pneumonectomy (PN) in non-small cell lung cancer (NSCLC). Material and Methods We performed a meta-analysis to comprehensively compare the mortality, morbidity, and locoregional recurrence of SL and PN in NSCLC. We also applied mean 5-year survival to compare the survival of SL and PN in NSCLC. Results A total of 24 studies met the defined criteria, 12 of which were used for meta-analysis, including 855 SL and 2072 PN. SL was associated with a decreased risk of operative mortality with a odds ratio 0.62(95% confidence limits, 0.41 to 0.94, P=0.02). The odds ratio of postoperative complications (SL vs PN) was 1.05(95% confidence limits,0.82 to 1.36, P=0.69), 1.07(95% confidence limits,0.51 to 2.26, P=0.86) for locoregional recurrence. There were 17 studies in SL and 13 studies in PN for the survival analyses. The overall mean 5-year survival was 0.48±0.10 in the SL group and 0.34±0.10 in the PN group, with statistical significance (P=0.004). The mean 5-year survivals for stage Ⅰ, Ⅱ and Ⅲ were 0.59±0.19, 0.42±0.11 and 0.23±0.10 in the SL group, 0.55±0.10, 0.42±0.12 and 0.20±0.04 in the PN group, respectively, which did not show a statistical significance (P=0.379, 0.918 and 0.538). The mean 5-year survivals for pNO, pN1 and pN2 were 0.63±0.09, 0.45±0.15 and 0.13±0.10 in the SL group, 0.48±0.14, 0.30±0.11 and 0.14±0.08 in the PN group, respectively. pNOand pNl were statistically significant (P=0.016 and 0.045), while pN2 had no statistical significance(P=0.890). Conclusion This systemic review suggests SL decrease the risk of operative mortality by 38%, however, postoperative complications and locoregional recurrence have no difference between SL and PN. The overall mean 5-year survival of the SL group is superior to that of the PN group. Performance of a SL rather than a PN for patients in pNO who are anatomically appropriate, regardless of underlying cardiopulmonary status, provides a lower operative mortality and an overall survival. SL should be done as many as possible for patients in pNl in order to decrease the operative mortality.