Abstract
Abstract
Introduction:
Sleeve lobectomy is a lung-sparing alternative to pneumonectomy for centrally located non-small cell lung cancer (NSCLC), but its safety after neoadjuvant therapy remains debated.
Methods
We performed a systematic review and meta-analysis of studies evaluating sleeve, bronchoplastic, bronchovascular, extended, or double sleeve resections after neoadjuvant therapy for NSCLC. Comparative outcomes were pooled using random-effects odds ratios (ORs). Primary outcomes were postoperative morbidity, airway/anastomotic complications, and short-term mortality.
Results
From 407 unique records, 29 primary studies were included qualitatively and 21 contributed to quantitative synthesis. Neoadjuvant therapy was not associated with significantly increased morbidity compared with upfront sleeve surgery (OR 1.20, 95% CI 0.88–1.63; I2 = 0%) or airway/anastomotic complications (OR 1.61, 95% CI 0.53–4.90). Compared with pneumonectomy after induction therapy, sleeve lobectomy showed lower morbidity (OR 0.53, 95% CI 0.29–0.97) and a lower but imprecise short-term mortality signal (OR 0.40, 95% CI 0.11–1.45). Chemoimmunotherapy did not increase postoperative complications versus chemotherapy alone (OR 0.65, 95% CI 0.31–1.33) and was associated with higher pathologic complete response (OR 5.42, 95% CI 1.94–15.14).
Conclusion
Sleeve lobectomy after neoadjuvant therapy appears feasible and generally safe in selected NSCLC patients treated in experienced centers. Sleeve resection should be favored over pneumonectomy when R0 resection is achievable, whereas chemoradiotherapy requires careful patient selection.