In this April 2025 issue of Annals of Thoracic Surgery (JCR Q1, IF: 3.6), a retrospective study, led by Professors Jianxing He and Shuben Li from the First Affiliated Hospital of Guangzhou Medical University, illustrated the safety, feasibility, and efficacy of extended sleeve lobectomy (ESL) after neoadjuvant immunochemotherapy in patients with centrally located non-small cell lung cancer (NSCLC).
The article entitled "Extended Sleeve Lobectomy After Neoadjuvant Immunochemotherapy for Centrally Located Non-small Cell Lung Cancer". It is the first study to evaluate the impact of neoadjuvant immunochemotherapy on ESL. The results demonstrated that ESL after neoadjuvant immunochemotherapy is a viable and safe option for selected patients with centrally located NSCLC to avoid pneumonectomy(PN), especially when standard sleeve lobectomy (SSL) is insufficient for R0 resection.
【Backgrounds】
Centrally located non-small cell lung cancer (NSCLC) often necessitates extensive parenchymal resection due to its aggressive nature and proximity to critical bronchovascular structures. Historically, PN has been regarded as the gold standard treatment for patients with central tumors. However, PN is associated with higher rates of mortality and morbidity, and significantly compromises pulmonary reserve, resulting in a substantial decline in lung function and quality of life.
Bronchoplasty techniques have emerged as promising alternatives for treating central NSCLC. Sleeve lobectomy (SL) has demonstrated more favorable outcomes than PN. When standard sleeve lobectomy (SSL) is not feasible, extended sleeve lobectomy (ESL) offers a potential solution to avoid PN. The safety and efficacy of SSL after neoadjuvant immunochemotherapy have been well confirmed. However, the safety and feasibility of ESL after such therapy remains controversial.
【Main findings】
A total of 94 patients with central non-small cell lung cancer (NSCLC) received neoadjuvant immunochemotherapy, followed by PN, ESL, or SSL, were retrospective collected. R0 resection was confirmed in 90 patients (95.7%), including 17 (94.4%) in ESL, 41 (97.6%) in SSL, and 32 (94.1%) in PN (P=0 .72). The result showed that the overall postoperative complication rate was 18.1% (17 of 94). Postoperative complications were predominantly observed in patients who underwent PN (32.4%), although the difference between ESL and pneumonectomy groups was not statistically significant. Kaplan-Meier curves showed no difference between ESL and SSL. Compared with PN, ESL had a longer event-free survival (P=0.04).
【Clinical significance】
ESL after neoadjuvant immunochemotherapy may be a safe and feasible alternative to pneumonectomy for selected patients with centrally located NSCLC. Despite its technical complexities, ESL may optimize outcomes by preserving lung function, reducing perioperative morbidity, and enabling adjuvant therapy access.
