Feasibility of video-assisted thoracoscopic sleeve lobectomy for non-small cell lung cancer

Purpose Sleeve lobectomy is a safe and effective surgical procedure for centrally located non-small cell lung cancer (NSCLC). However, the use of video-assisted thoracoscopic surgery (VATS) on bronchial sleeve resection is still controversial due to a lack of evidence. In this study, we describe our experience on VATS sleeve lobectomy and evaluate its feasibility for treating NSCLC. Methods From January 2010 to May 2019, VATS sleeve lobectomy was attempted in 19 patients with NSCLC at Samsung Medical Center. Their baseline characteristics, perioperative data, and survival outcome were collected and analyzed retrospectively. Results Of the 19 patients, 10 underwent VATS sleeve lobectomy successfully. The mean age of the patients who underwent successful VATS was 53.5± 15.8 years, and all the patients were men. Seven patients (70%) had squamous cell carcinoma. The mean postoperative chest tube drainage duration was 5.3± 2.3 days, and the median hospital stay duration was 7 days (interquartile range, 6.25 to 11.5 days). Among the patients who underwent successful VATS, two had postoperative bronchial stenosis: One patient underwent complete pneumonectomy, and one patient was observed without any intervention. During the median follow-up duration of 3.5 years, two patients with squamous cell carcinoma who underwent successful VATS died. Of these, one died 70 days postoperatively because of acute respiratory distress syndrome and one died 18 months postoperatively from an unknown cause. No patient had locoregional recurrence. Conclusion VATS sleeve lobectomy is a feasible surgical procedure for centrally located tumors without vascular invasion.