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Sleeve Lobectomy And Pneumonectomy: A Functional Comparison
A. Zuin1, G. Marulli1, R. Bulf1, C. Breda1, C. Schiraldi2, G. Rizzardi1, F. Sartori1, F. Rea1. 1Thoracic Surgery - University of Padua, Padua, Italy, 2Division of Respiratory Medicine - University of Padua, Padua, Italy,
BACKGROUND:
To assess and compare the effects of sleeve lobectomy and pneumonectomy for lung cancer on postoperative respiratory function and exercise capacity.
METHODS:
From January 1980 to December 2004, 610 patients underwent pneumonectomy and 220 sleeve lobectomy for lung cancer in our Division.
From these, two groups of 50 patients each with homogeneous preoperative pulmonary function were selected and postoperatively studied by standard spirometry after a mean of 31 and 38 months from pneumonectomy and sleeve lobectomy, respectively.
Moreover, 20 patients for each groups performed maximal exercise test, in order to quantify the exercise capacity at a mean of 43 and 42 months after operation.
Differences between pre and post-operative spirometric values, including static volumes and dynamic flows (VC, RV, FEV1 and FEF 25/75%) and exercise test parameters (VO2 max, VECO2, VEO2 and maximal work load Wmax) were analysed with Student’s t-test.
RESULTS:
Stage by stage 5-year survival rate after sleeve lobectomy and pneumonectomy was comparable, respectively 71% and 57% for N0, 34,5% and 25,2% for N1, 19,1% and 11,8% for N2.
Sleeve lobectomy group showed a significantly lower decrease of spirometric parameters VC, RV and FEV1 (p < 0,001) and an higher postoperative maximal work load capacity (p<0,05). FEF 25/75%, VO2 max, VECO2 and VEO2 showed no significant differences.
CONCLUSIONS:
Sleeve lobectomy for lung cancer brings comparable results with pneumonectomy in long term survival, preserving better respiratory function.
Therefore, sleeve resections, whenever feasible, should be considered an effective alternative to pneumonectomy, not restricted to patients with compromised pulmonary function.
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