Evolution of a Lung-Sparing Strategy with Sleeve Lobectomy and Induction Therapy for XXXX : 20-Year Experience at a Single Institution.

@entity1149 @entity1 @entity9876 @entity5
BACKGROUND: To elucidate the evolution of a lung-sparing strategy with @entity9876 ( @entity9876 ) and induction therapy for @entity1149 ( @entity1149 ). METHODS: We retrospectively reviewed 205 @entity1 with @entity1149 who underwent pneumonectomy (PN, n  =  54) or @entity9876 (n  =  151) from 1994 to 2013. The study period was divided into four 5-year periods, and surgical trends were analyzed, focusing on the PN: @entity9876 ratio. RESULTS: PN was associated with a significantly advanced pathological stage, a larger @entity5 size and less pulmonary function compared with @entity9876 . The PN group had higher 30-day (3.7 vs. 0  %, p  =  0.018) and 90-day (13.0 vs. 1.3  %, p  =  0.0003) mortality than the @entity9876 group. The overall 5-year survival rate was significantly higher with @entity9876 (71.5  %) versus PN (42.8  %, p  =  0.011) for @entity1 with pN0-1. The ratio of PN among total surgeries decreased significantly over the four periods (1994-1998, 1999-2003, 2004-2008, and 2009-2013) from 5.63  % to 3.17, 1.40, and 1.38  %, respectively (p  <  0.0001); in contrast, the PN: @entity9876 ratio increased significantly from 1.64 to 2.50, 3.71, and 5.44, respectively (p  =  0.041). During the last period, when we introduced induction therapy, 38 of 651 who received surgery underwent induction therapy. The PN: @entity9876 ratios of those who did and did not undergo induction therapy were 15 (PN: 1, @entity9876 : 15) and 4.25 (PN: 8, @entity9876 : 34), respectively. CONCLUSIONS: A lung-sparing strategy with @entity9876 for @entity1149 can decrease the PN rate to less than 2  % with less mortality. Induction therapy may facilitate @entity9876 and increase the PN: @entity9876 ratio.
