Extended Indications for Sleeve Lobectomy: A Single-Center Experience of Surgical Management of Central Pulmonary Metastases.

BACKGROUND: The role of bronchial sleeve resection for centrally located pulmonary metastases remains poorly defined, as surgery in metastatic disease is often perceived as excessively aggressive. However, in selected patients, this parenchyma-sparing technique may offer durable local control and significant symptomatic relief. This study reports a single-center experience with sleeve resections performed for metastatic, centrally located pulmonary lesions. METHODS: All consecutive patients undergoing bronchial sleeve resection for metastatic disease at Padua University Hospital between January 2000 and August 2025 were retrospectively reviewed. Clinical characteristics, operative details, perioperative outcomes, and follow-up data were collected. Patients treated with sleeve resections for primary lung cancer were excluded. RESULTS: Eighteen patients were included. Most had good performance status, and 66% received preoperative systemic therapy. Single sleeve resections were performed in 72% and double sleeves in 28%. Surgical access was thoracotomy in 72% and VATS in 28%. No in-hospital, 30-day, or 90-day mortality occurred. Postoperative symptom resolution was achieved in 94% of patients. The most frequent histology was colorectal adenocarcinoma. Median follow-up was 26 months, with a median disease-free survival of 22 months. Local recurrence occurred in only one case, and no bronchial stump recurrences were observed. CONCLUSION: Bronchial sleeve resection for centrally located pulmonary metastases can be feasible and safe in a carefully selected subset of patients. It provides effective restoration of airway patency, good local control, and acceptable long-term outcomes. Larger multicenter studies are needed to further clarify its role within multidisciplinary management.