Bronchoplastic Lobectomy Versus Pneumonectomy For Central Non-Small Cell Lung Cancer: A Comparative Cohort Study

Introduction . Pneumonectomy (PE) and bronchoplastic lobectomy (BPL) allow for radical removal of the central tumor, while the latter also preserves functioning lung parenchyma. Comparison of these procedures is complicated by differences in tumor prevalence and patient selection. Objective. To compare short- and long-term outcomes of BPL and PE for central non-small cell lung cancer. Materials and methods . This retrospective single-centre cohort study included operations performed in 2017– 2025. The primary comparison included 180 patients: 88 underwent BPL and 92 underwent PE. Postoperative complications, 30‑and 90‑day mortality, overall survival (OS), and event-free survival (EFS) were assessed. Results . Clavien — Dindo grade III–V complications occurred in 10/88 (11.4 %) patients after BPL and 6/92 (6.5 %) after PE (p = 0.263); 90‑day mortality was 5/88 (5.7 %) and 6/92 (6.5 %), respectively (p = 0.814). Five-year OS was 71.6 % after BPL and 52.5 % after PE (log-rank p = 0.057), while five-year EFS was 67.9 % and 47.8 %, respectively (log-rank p = 0.041). In adjusted multivariable Cox proportional hazards models, PE versus BPL was not significantly associated with the hazard of death (HR, 1.69; 95 % CI, 0.96–2.98; p = 0.068) or an event (HR, 1.66; 95 % CI, 0.98–2.81; p = 0.058). Discussion . The unadjusted survival differences may reflect the higher proportion of stage II–III disease in the PE group. The findings support parenchyma-sparing surgery as an acceptable treatment option but do not demonstrate its independent superiority. Conclusion . BPL is a reasonable option for central non-small cell lung cancer and, in this cohort, was not associated with higher rates of major complications or early mortality than PE.