ABSTRACT

In centrally located lung cancer, resection is frequently associated with massive parenchyma extirpation and high rates of morbidity and mortality. Pneumonectomy (PN) has a significantly greater incidence of mortality compared with lesser pulmonary resections and results in substantial declines in lung function and quality of life, precluding adjuvant treatments or further lung resection. Management of centrally located non-small-cell lung cancer may combine various surgical techniques to avoid PN without compromising the long-term oncological results. Surgical options include PA reconstruction or replacement, alleviation of bronchial mismatch, and in some cases, resection of more than one lobe and airway anastomoses in segmental bronchi. Overall, PA reconstruction has proven to be a reliable and useful operation for parenchymal sparing in central tumors and, compared with PN, offers better immediate and long-term results in terms of complications, survival, quality of life, and substantially better respiratory function. Sleeve lobectomies can be performed safely and should be considered in all central tumors in lieu of PN.