Bronchial sleeve lobectomy with pulmonary artery reconstruction following neoadjuvant chemoimmunotherapy: A propensity score–weighted comparison

Objective: To evaluate the feasibility and safety of bronchial sleeve lobectomy (BSL) with pulmonary artery reconstruction (PAR) following neoadjuvant chemoimmunotherapy.Methods: Patients undergoing sleeve lobectomy or pneumonectomy after neoadjuvant chemoimmunotherapy between 2019 and 2023 were enrolled in the analysis retrospectively.Perioperative outcomes, overall survival, and event-free survival were compared among the BSL, BSL with PAR, and pneumonectomy (PN) groups before and after propensity score matching weights (MW).Results: In the overall cohort, 143 patients received simple BSL, 49 received BSL with PAR, and 48 underwent PN.There were marked differences in the distribution of age, clinical N stage, and tumor location among the 3 groups.After MW, BSL with PAR was associated with a higher thoracotomy rate (P = .011),longer operative time (P = .007),and more intraoperative blood loss (P < .001)compared with BSL and PN.The incidences of surgery-related complications (33.1% vs 49.3%) and severe complications (28.1% vs 45.8%) was lower and the hospital stay was shorter (median, 6 days vs 9 days) in the BSL with PAR group compared to the PN group.There was no significant discrepancy in postoperative complication rates between BSL with PAR and BSL after MW.Multivariable logistic regression analysis revealed that compared to PN, BSL with PAR served as a protective factor for both postoperative complications (P = .042)and severe complications (P = .014).Kaplan-Meier analysis further suggested that BSL with PAR was associated with favorable overall survival compared to PN after MW (P = .027).Conclusions: BSL with PAR can be recognized as a safe and feasible surgical procedure even after neoadjuvant chemoimmunotherapy.(JTCVS Open 2025;