Extended Sleeve Lobectomy After Neoadjuvant Immunochemotherapy for Centrally Located Non-Small Cell Lung Cancer

Extended sleeve lobectomy (ESL) is considered a lung-sparing alternative to pneumonectomy (PN) for centrally located non-small cell lung cancer (NSCLC) when standard sleeve lobectomy (SSL) is not feasible. This retrospective study analyzed 94 patients who received neoadjuvant immunochemotherapy followed by either PN, ESL, or SSL. Patients undergoing ESL demonstrated lower predicted postoperative lung function compared to those who underwent PN. R0 resection rates were high across all groups, ranging from 94 to 98 percent, and postoperative complications were most frequent after PN (32.4 percent). Survival analysis showed no significant difference between ESL and SSL, but ESL offered longer event-free survival compared to PN. These findings indicate that ESL after neoadjuvant immunochemotherapy is a safe and effective option for selected patients, allowing for lung preservation without compromising oncologic outcomes, especially when SSL is insufficient for complete tumor removal.