Pulmonary Sleeve Resection

Pneumonectomy, while effective at removing lung tumors, can carry high morbidity and mortality by removing an entire half of a person's lung volume. Pulmonary resection techniques are varied and categorized by the extent of lung resected. Pulmonary resection (PSR) is a broad term to describe circumferential excision of a part of the bronchus and/or pulmonary vessels during lung parenchyma resection while preserving the uninvolved portions of the lung. Bronchoplasty or vascular reconstructions are incorporated techniques where the two separate pieces of remaining bronchus or vessels are re-anastomosed. The most common indication is for lung neoplasm. When discussing PSR with lobectomy, or one lobe of the lung, the term sleeve lobectomy (SL) is commonly used. Some papers have also used the terms extended to describe resection characteristics when more than one lobe is resected. PSR was first attempted in the late 1940s for a benign mass to preserve lung function. In the mid-late 1950s, the feasibility of PSR for lung cancer was proven. By the early 1980s, SL was gaining traction with the technique used to treat low-grade lung malignancies. The oncologic and functional results after SL are predominantly studied in patients with centrally located non-small cell lung cancer. A meta-analysis demonstrated better survival and quality of life in patients with early-stage locally advanced lung cancer who underwent PSR, as compared to traditional pneumonectomy. With advancements in perioperative care and a better understanding of lung-sparing surgeries' oncologic benefits for locally advanced central lung cancers, PSR techniques are now the preferred approach, even in patients with good pre-operative pulmonary reserve.Improvement in video-assisted thoracic surgery (VATS) and robotic surgery platforms have allowed complex lung resections such as SL to be performed via minimally invasive approaches. There is now mounting literature establishing the safety and feasibility of SL using minimally invasive surgical techniques. PSR is already considered a technically challenging thoracic surgical procedure, so only certain centers will have the necessary expertise in performing PSR using minimally invasive techniques. It is notable that even though minimally invasive techniques are becoming more common for lobectomies, SL is still a smaller portion of all lobectomies performed.Compared to pneumonectomy, PSR has improved survival, quality of life, improved pulmonary function, and lower mortality rates. Although initially used for patients unable to tolerate pneumonectomy, PSR is now a preferred approach for anatomically suitable tumors.