Sleeve Lobectomy, Pulmonary Artery Plasty, and Superior Vena Cava Reconstruction for Locally Advanced Non-small Cell Lung Cancer: A Single-Center Retrospective Study.

Abstract

Background: Reconstruction of the superior vena cava (SVC) and sleeve resection of the bronchus and pulmonary artery (PA) simultaneously for right upper lobe central-type non-small cell lung cancer (NSCLC) present technical challenges for surgeons. Here, we described our experience with this surgical procedure and the clinical outcomes.

Patients and methods: We retrospectively collected clinical data of 15 patients from 31 January 2014 to 30 December 2023 who underwent SVC resection combined with sleeve resection of the bronchus and/or PA. The surgical approaches were described from two typical patients and the overall survival (OS) of those patients was reported.

Results: Among the 15 patients, 9 (60%) patients received neoadjuvant therapy, and all the patients received adjuvant therapy. All resections were completely resectable (R0). Histologically, seven patients (46.7%) had adenocarcinoma and eight (53.3%) patients had squamous cell carcinoma. In addition, 1 (6.7%) patient was classified as having stage pT4N0M0-IIIA, 12 (80%) were pT4N2M0-IIIB, and 2 were pT4N3M0-IIIC. No perioperative deaths occurred. The major complication rate was 40% after surgery. The median follow-up duration was 29 months, with survival times ranging from 3 to 64 months, and the median survival time was 18 months. In addition, the OS rates at 1, 3, and 5 years were 80%, 28.6%, and 28.6%, respectively.

Conclusions: Combined resection of the bronchus, PA, and SVC is technically feasible and safe for patients with locally advanced NSCLC. For carefully selected patients, this extended resection surgery may lead to favorable long-term survival.