Comparison of Short- and Long-term Outcomes in Patients Undergoing Sleeve Lobectomy With or Without Buttressing the Bronchial Anastomosis.

Abstract

Background: This study evaluated whether buttressing the bronchial anastomosis with an autogenous pedicled flap has short- and long-term advantages for patients undergoing sleeve lobectomy.

Methods: Consecutive patients who underwent bronchial sleeve lobectomy for centrally located non-small cell lung cancer were retrospectively identified. Perioperative outcomes, recurrence-free survival, and overall survival were compared between those who received anastomosis coverage and those who did not before and after stable inverse probability of treatment weighting (IPTW).

Results: The study included 682 patients. Among them, 211 patients (30.9%) received anastomosis coverage (143 pleura, 39 intercostal muscle, and 29 pericardial or vein flap), and the other 471 (69.1%) did not. Perioperative outcomes were comparable except for more operative time (P = .028) in patients with anastomosis coverage after IPTW. Multivariable logistic regression analysis revealed that buttressing the anastomosis did not lead to fewer postoperative complications (odds ratio, 0.95; 95% CI, 0.60-1.52; P = .842). No significant difference was observed in long-term survival between the 2 groups before and after IPTW. Multivariable Cox regression analysis demonstrated that wrapping the anastomosis was not associated with favorable long-term recurrence-free survival (hazard ratio, 1.04; 95% CI, 0.81-1.35, P = .737) or overall survival (hazard ratio, 0.97; 95% CI, 0.72-1.30; P = .819) for patients undergoing sleeve lobectomy in the IPTW-adjusted cohort.

Conclusions: Our results indicated that buttressing the bronchial anastomosis does not reduce the incidence of postoperative complications or confer survival benefits to patients undergoing sleeve lobectomy.