Considerations of Sleeve Lobectomy with Microscopic Margin Disease or Extensive Pneumonectomy for Non-Small Cell Lung Cancer Patients

Background: For patients with non-small cell lung cancer (NSCLC), microscopic residual disease (R1) is sometimes inevitable after sleeve lobectomy. However, the necessity for extensive pneumonectomy (PNE) after sleeve lobectomy with R1 status remains unclear, especially when the patient cannot tolerate surgery.<br><br>Methods: We retrospectively collected the clinical data of 366 patients who underwent sleeve lobectomy for microscopic residual disease (SLobR1) or PNE between 2015 and 2019 at Shanghai Chest Hospital, China. We used propensity score matching to balance the baseline characteristics between the SLobR1 and PNE groups and then analyzed the survival outcomes (overall survival [OS] and progression-free survival [PFS]).<br><br>Results: Propensity score matching balanced the baseline characteristics, resulting in 93 patients per group. OS and PFS did not differ between the SLobR1 and PNE groups. However, the subgroup analysis indicated that residual disease negatively affected early stage I disease in the SLobR1 group compared to the PNE group. In addition, the causes of death did not differ between the groups. Moreover, radiotherapy improved OS (P = 0·021) and considerably decreased the incidence of distant recurrence, similar to other studies. However, it increased the risk of extrathoracic lymph node metastasis.<br><br>Conclusion: Palliative SLobR1 is acceptable, especially for patients who cannot tolerate extensive PNE. Furthermore, radiotherapy is necessary to reduce the recurrence risk.<br><br>Funding Information: This study was funded by National Natural Science Fundation of China Project No. 81871497.<br><br>Declaration of Interests: All authors have no conflicts of interest to declare.<br><br>Ethics Approval Statement: This study was approved by Ethics Committee in Shanghai Chest hospital.