Parenchyma-Sparing Strategy in Central Non-Small Cell Lung Cancer: An Institutional Experience on Surgical Selection, Complications, and Survival

Background/Objectives: Sleeve lobectomy serves as a parenchyma-sparing alternative to pneumonectomy for central non-small cell lung cancer (NSCLC). This study describes and compares early postoperative outcomes and overall survival between sleeve lobectomy and pneumonectomy and explores factors associated with survival. Methods: A retrospective cohort analysis was conducted on 97 consecutive patients with central NSCLC operated at the Marius Nasta National Institute of Pneumophthisiology between September 2021 and December 2022, with follow-up through 1 March 2025. Patients were divided into two groups: sleeve lobectomy (n = 41) and pneumonectomy (n = 56). Early morbidity, mortality, and overall survival were evaluated using univariate analysis and multivariable Cox proportional hazards regression. Results: After multivariable adjustment, surgical procedure was not significantly associated with overall survival. A low rate of major anastomotic complications was observed in the sleeve lobectomy group, with one case of early partial anastomotic leak (2.44%) requiring surgical reinforcement. In an exploratory multivariable model, pathological nodal involvement and the number of involved lymph nodes were associated with mortality. Conclusions: In appropriately selected patients where an R0 parenchyma-sparing resection is technically feasible, sleeve lobectomy is associated with acceptable morbidity and survival. After adjustment, the surgical procedure was not significantly associated with overall survival. Nodal disease burden was the factor most strongly associated with survival in this cohort.