Outcomes of right sleeve lower lobectomy vs. lower bilobectomy for lung malignancies

Objectives: Lower bilobectomy (LBL) leaves a residual pleural space potentially associated with adverse postoperative outcomes. In selected patients, right sleeve lower lobectomy (RSLL) with anastomosis between the middle lobe bronchus and intermediate bronchus is feasible. The outcomes of RSLL and LBL have not been compared. The aim of this study was to compare post-operative and long-term outcomes of RSLL and LBL in patients with lung cancer. Methods: We retrospectively included patients managed by RSLL or LBL at our referral chest-surgery institution between 2001 and 2019. Post-operative complications and mortality were compared. Kaplan-Meier curves were plotted to compare overall and disease-free survival rates. Results: We identified 23 patients with RSLL and 96 with LBL. Postoperative mortality was 9 % after RSLL and 5 % after LBL (p = 0.41). Bronchial fistula developed in 3 (13 %) RSLL patients and 6 (6 %) LBL patients (p = 0.23). Pleural space complications were significantly less common after RSLL (4/23 [17 %] vs. 45/96 [47 %], p = 0.03). Long-term vital capacity was significantly higher in the RSLL group (91 % vs. 64 %, p < 0.01). Five-year survival did not differ significantly between groups (84 % vs. 72 %, p = 0.09). Conclusions: RSLL was associated with similar postoperative mortality and long-term survival compared to LBL. However, pleural space complications were less common and lung function was better after RSLL than after LBL. When feasible, RSLL may deserve preference over LBL in patients with lung cancer managed at highly experienced centres.