Surgical outcomes of sleeve versus standard lobectomy in patients with non–small cell lung cancer: A systematic review and meta-analysis.

Abstract

e20084 Background: Sleeve lobectomy is a parenchyma-preserving alternative to standard lobectomy for centrally located non–small cell lung cancer (NSCLC), yet its perioperative superiority compared with standard lobectomy remains unclear. This meta-analysis aimed to compare surgical and postoperative outcomes between these two procedures. Methods: A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was performed from inception to August 2025. Observational studies published in English comparing sleeve and standard lobectomy in NSCLC were included. Pooled estimates were calculated using a random-effects model, and results were expressed as mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs). All statistical analyses were performed at R software (version 4.4). This study is registered in PROSPERO under the protocol number CRD420251128001. Results: From 1058 articles, we included 4 retrospective cohort studies encompassing 1,235 patients. Sleeve lobectomy was associated with a significantly longer operative time (MD = 25.93 minutes; 95% CI 2.49–49.36; p = 0.041; I² = 53.5%) but showed no significant difference in length of hospital stay (MD = –0.30 days; 95% CI –2.92–2.32; p = 0.671) or overall mortality (OR = 3.88; 95% CI 0.00–3951.25; p = 0.243; I² = 47.5%) compared with standard lobectomy. Similarly, there were no significant differences between the two technique regarding overall surgical complications (OR = 1.11; 95 % CI 0.57-2.17; p = 0.470; I2 = 0%) atrial fibrillation (OR = 1.17; 95% CI 0.36–3.86; p = 0.701; I² = 70.3%), pneumonia (OR = 0.84; 95% CI 0.45–1.59; p = 0.454; I² = 5.4%), prolonged air leak (OR = 0.88; 95% CI 0.47–1.67; p = 0.491; I² = 0%), or overall complications (OR = 1.11; 95% CI 0.57–2.17; p = 0.470; I² = 0%). Conclusions: Sleeve lobectomy offers comparable perioperative safety and postoperative outcomes to standard lobectomy in patients with NSCLC, with a modest increase in operative time. These findings support sleeve lobectomy as a safe, function-preserving, and potentially promising surgery option for NSCLC.