Surgical access and other prognostic factors influencing early and long-term outcomes after sleeve lobectomy in patients with centrally located lung cancer

Objective. To improve the treatment outcomes of patients with central lung cancer by optimizing surgical approach. Material and methods. This retrospective multicenter study included 63 patients with I—III stage of central NSCLC who underwent sleeve lobectomy from May 2014 to April 2024 at three thoracic surgery centers in St. Petersburg. Results. The frequency of postoperative complications in I—II stage of central non-small cell lung cancer was 33.3% in the group of videothoracoscopic sleeve resections versus 61.1% in thoracotomy group (p=0.018). The overall 5-year survival rate was 61% in the thoracotomy group versus 90% in the videothoracoscopy group(p=0.046). Risk factors for the development of postoperative complications after sleeve lobectomies included thoracotomy (p=0.003), high body mass index (p=0.043), advanced stage of the tumor (p=0.002), and lack of covering of the bronchial anastomosis with flap (p=0.032). Independent unfavorable prognostic factors of long-term survival in patients after sleeve lobectomy include high body mass index (p=0.003), smoking history (p=0.009), intraoperative blood transfusion (p=0.036), and conversion of thoracoscopic access to thoracotomy (p=0.007). Conclusion. Videothoracoscopic sleeve lobectomies are associated with less postoperative complications in patients with I—II stages of central NSCLC, which allows to reliably reduce the incidence of postoperative complications and ensure good long-term treatment results. Several risk factors of complicated postoperative period and poor long-term survival were identified by multivariate analyzis.