Sleeve resection or double sleeve resection can preserve pulmonary function and improve the survival outcomes compared to pneumonectomy. A novel procedure was introduced for surgical treatment of centrally located lung cancer in left upper lobe, in which transpositional anastomosis of left inferior lobe pulmonary artery and pulmonary artery trunk was conducted.

From June 2014 to May 2024, patients receiving the transpositional anastomosis of left inferior lobe pulmonary artery and pulmonary artery trunk for double sleeve resection in centrally located lung cancers at Shanghai Chest Hospital were retrospectively reviewed.

Ten patients were included in this study, among whom 4 patients received neoadjuvant therapy. The median operation time was 175 minutes. The median duration of intensive care unit stay was 3 days, the median duration of chest tube drainage was 6 days, and the median length of hospital stay was 12 days. No operative death or complication occurred. Pathological examination confirmed all negative margins, 6 cases of N1 lymph node metastasis and 2 cases of N2 lymph node metastasis. Eight patients underwent postoperative adjuvant therapy. Four patients were lost and the median follow-up time for the remaining 6 cases was 10 months with the maximum follow-up time reaching 32 months.

When the left pulmonary artery is totally involved, the transpositional anastomosis of left inferior lobe pulmonary artery and pulmonary artery trunk for double sleeve resection is feasible and effective to achieve long-segment pulmonary artery resection and avoid positive margins, which could be an alternative to pneumonectomy.