A multicenter retrospective study on surgical outcomes of lobectomy with pulmonary arterioplasty versus pneumonectomy for centrally-located left upper lobe non-small cell lung cancer

Lobectomy with pulmonary arterioplasty is a crucial option for preserving lung function and has been performed safely despite its technical complexity. Recent advancements in chemotherapy, particularly the introduction of molecular targeted therapies and immune checkpoint inhibitors, have improved the prognosis of patients with advanced lung cancer. These perioperative treatments are more feasible when surgical invasiveness is minimized. Perioperative outcomes and prognostic data were collected from 86 patients who underwent either lobectomy with pulmonary arterioplasty or pneumonectomy for centrally located left upper lobe non-small cell lung cancer at multiple centers between January 2012 and December 2020. A total of 67 patients underwent lobectomy, while 19 underwent pneumonectomy. There were no significant differences in operative time or intraoperative blood loss. Postoperative complications occurred in 50.7 % of the lobectomy group and 73.7 % of the pneumonectomy group, though the difference was not statistically significant. Atrial fibrillation was significantly more frequent in the pneumonectomy group. Respiratory function was better preserved in the lobectomy group. The recurrence rate was similar between the two groups, and postoperative treatments were administered at comparable rates. The 5-year overall survival rate was 69.5 % in the lobectomy group and 40.0 % in the pneumonectomy group, with no significant difference. Lobectomy with pulmonary arterioplasty for left upper lobe non-small cell lung cancer resulted in fewer postoperative complications, better preservation of respiratory function, and comparable prognosis to pneumonectomy, making it a preferable surgical option.