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Minerva Chirurgica 2006 August;61(4):307-13


language: Italian

Technique, results and impact of induction chemotherapy in sleeve lobectomy for lung cancer

Borri A. 1, Leo F. 1, Galetta D. 1, Veronesi G. 1, Solli P. 1, Petrella F. 1, Gasparri R. 1, Scanagatta P. 1, Spaggiari L. 1, 2

1 Divisione di Chirurgia Toracica Istituto Europeo di Oncologia, Milano 2 Facoltà di Medicina e Chirurgia Università degli Studi di Milano, Milano


Aim. The aim of this study was to evaluate the safety of continuous nonabsorbable (3/0 polypropylene) sutures for sleeve lobectomy, and the influence of induction chemotherapy on postoperative outcome in patients with lung malignancies.
Methods. A review of a prospective database of a single surgeon identified 41 consecutive patients who underwent sleeve lobectomy from May 1998 to July 2003. Bronchial reconstruction was done placing two 3/0 polypropylene sutures at the far side of the cartilaginous wall and subsequently fixed. Afterwards, two running sutures were performed in order to obtain a telescopic anastomosis.
Results. Twenty-four patients (59%) underwent induction chemotherapy. There were 31 right upper, 3 left lower “reverse”, and 7 left upper sleeve lobectomies with radical lymph node dissection. Eight patients underwent reconstruction of the pulmonary artery. There were 34 non-small cell lung cancers, 3 limited small cell lung cancers, 1 neuroendocrine large cell carcinoma, and 3 bronchial carcinoid tumors. N2, N1, and N0 diseases were found in 13, 12 and 16 patients, respectively. Post-operative morbidity and mortality were 14.5% (n=6) and 4.8% (n=2) (1 patient, 4%, after induction chemotherapy). The rate of postoperative anastomotic complications was 2.4% (n=1). Late bronchial stenosis developed in 3 cases, but all were successfully medically treated. Twenty-nine patients are still alive, 27 without evidence of disease. The overall 2-year probability of survival (Kaplan-Meier) was 59%. Induction chemotherapy did not influence postoperative morbidity/mortality (c2 test: P=0.64/P=0.56).
Conclusions. Continuous nonabsorbable suture for sleeve lobectomy is quick and technical easy to perform, with low postoperative morbidity/mortality; induction chemotherapy does not influence postoperative outcome in these patients.

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