Extended Sleeve Lobectomy After Neoadjuvant Immunochemotherapy for Centrally Located Non-Small Cell Lung Cancer

J. Chen¹, Z. Zhao², H. Deng¹, R. Wang¹, Z. li³, D. Zhang¹, J. He¹, S. Li^1
1the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong ²Sun Yat–sen University Cancer Center, Guangzhou, Guangdong ³The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong

Purpose: Extended sleeve lobectomy (ESL) is proposed as an effective alternative to pneumonectomy (PN) for patients who are not amenable to standard sleeve lobectomy (SSL), which is designed to preserve more lung parenchyma and improve postoperative quality of life. However, the safety and feasibility of ESL after neoadjuvant immunochemotherapy remain unclear.

Methods: Ninety-four patients with central non-small cell lung cancer (NSCLC) treated with neoadjuvant immunochemotherapy followed by PN, ESL, or SSL between 2019 and 2023 were included in this study. Perioperative, surgical, pathological, and survival outcomes were meticulously analyzed to evaluate the impact of neoadjuvant immunochemotherapy.

Results: The numbers of patients who underwent ESL, SSL, and PN were 18 (19.1%) , 42 (44.7%), and 34 (36.2%) respectively. According to the ESL classification, 10 patients (55.6%) were with type A, 2 (11.1%) with type B, 2 (11.1%) type C and 4 (22.2%) with type D. Patients who underwent ESL had a poorer predicted postoperative FEV1% than PN (34.3±6.8% vs. 43.7±7.1%, P< 0.01) if pneumonectomy was conducted. There was no difference in morbidity between ESL and PN groups (P=0.18), or between ESL and SSL groups (P=0.10). 17 (94.4%) in ESL group, 41 (97.6%) in SSL group, and 32 (94.1%) in PN group (P=0.72) confirmed R0 resection. The median duration of follow-up time was 16 months (range, 3 to 53 months). No significant difference was detected for the pattern of recurrence among the 3 groups (p=0.28). Kaplan-Meier analysis revealed no difference in either disease-free survival or event-free survival between the ESL group and SSL group (P=0.70 and 0.83, respectively). To be noted, ESL demonstrated better long-term outcomes than PN in terms of DFS (40.1±4.8 m vs. 26.2±3.7 m, P=0.08). And a significant difference in EFS was detected between the ESL and PN groups (ESL: 43.6±4.8 m vs. PN: 28.8±3.9 m, P=0.04).

Conclusion: ESL after neoadjuvant immunochemotherapy is a viable and safe option for selected patients with centrally located NSCLC to avoid PN, especially when SSL is insufficient for R0 resection.

Identify the source of the funding for this research project: None