Comparison of Short- and Long-term Outcomes in Patients Undergoing Sleeve Lobectomy With or Without Buttressing the Bronchial Anastomosis.

Abstract

This study evaluated whether buttressing the bronchial anastomosis with an autogenous pedicled flap has short- and long-term advantages for patients undergoing sleeve lobectomy. Consecutive patients who underwent bronchial sleeve lobectomy for centrally located non-small cell lung cancer were retrospectively identified. Perioperative outcomes, recurrence-free survival, and overall survival were compared between those who received anastomosis coverage and those who did not before and after stable inverse probability of treatment weighting (IPTW). The study included 682 patients. Among them, 211 patients (30.9%) received anastomosis coverage (143 pleura, 39 intercostal muscle, and 29 pericardial or vein flap), and the other 471 (69.1%) did not. Perioperative outcomes were comparable except for more operative time (P = .028) in patients with anastomosis coverage after IPTW. Multivariable logistic regression analysis revealed that buttressing the anastomosis did not lead to fewer postoperative complications (odds ratio, 0.95; 95% CI, 0.60-1.52; P = .842). No significant difference was observed in long-term survival between the 2 groups before and after IPTW. Multivariable Cox regression analysis demonstrated that wrapping the anastomosis was not associated with favorable long-term recurrence-free survival (hazard ratio, 1.04; 95% CI, 0.81-1.35, P = .737) or overall survival (hazard ratio, 0.97; 95% CI, 0.72-1.30; P = .819) for patients undergoing sleeve lobectomy in the IPTW-adjusted cohort. Our results indicated that buttressing the bronchial anastomosis does not reduce the incidence of postoperative complications or confer survival benefits to patients undergoing sleeve lobectomy.