Long-Term Survival after Extended Sleeve Lobectomy (ESL) for Central Non-Small Cell Lung Cancer (NSCLC): A Meta-Analysis with Reconstructed Time-to-Event Data.

Autor: Magouliotis DE; Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece., Zotos PA; Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece., Karamolegkou AP; Department of Anesthesiology, Hippocration General Hospital of Athens, 41500 Athens, Greece., Tatsios E; Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece., Spiliopoulos K; Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece., Athanasiou T; Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London W2 1NY, UK.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2022 Dec 27; Vol. 12 (1). Date of Electronic Publication: 2022 Dec 27.
DOI: 10.3390/jcm12010204
Abstrakt: Objective: We conducted a thorough literature search on patients with central non-small cell lung cancer (NSCLC) undergoing either extended sleeve lobectomy (ESL) or pneumonectomy (PN).
Methods: We identified all original research studies that compared the long-term survival of ESL versus PN from 1990 to 2022. The primary endpoints were the median overall survival (OS) and disease-free survival (DFS). Complications, operative mortality, and the reoperation rate were the secondary endpoints. Regarding the primary endpoints, independent patient data were extracted from the included studies, and pooled Kaplan-Meier curves were constructed. A sensitivity analysis was performed using the leave-one-out method.
Results: Nine studies were included in the qualitative and seven in the quantitative synthesis, including 431 patients. Patients in the ESL group demonstrated a significantly higher OS compared with the PN group (HR, 0.63; 95% CI, 0.46-0.87; p = 0.005). In addition, patients undergoing ESL presented a significantly higher DFS compared to the PN group (HR, 0.57; 95% CI, 0.40-0.80; p = 0.004). These findings were further validated with a sensitivity analysis. The most common complications in the ESL group were bronchopleural fistula (4.6%), stricture (3.1%), prolonged air leakage (7.3%), sputum retention (4.6%), pneumonia (7.7%), and pulmonary vein thrombosis (1.5%). ESL was associated with a low reoperation rate (1.5%) and operative mortality (1.2%).
Conclusions: The present meta-analysis indicates that ESL is associated with enhanced survival outcomes compared to PN for patients with central NSCLC. Further randomized controlled trials are necessary to validate our findings.
Databáze: MEDLINE
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