500 Consecutive Robotic Lobectomies for Non-Small Cell Lung Cancer: Perioperative and Oncologic Outcomes

Abstract

Objective Clinical adoption of robotic lobectomy for management of lung cancer is rapidly increasing across the world. Several studies have evaluated the technique with regards to perioperative and cost outcomes, with evidence beginning to grow regarding long-term oncologic outcomes. We report perioperative and oncologic outcomes in our single institution experience with 500 consecutive robotic lobectomies, including a significant portion for locally advanced disease. Methods This study is a retrospective review of the first 500 robotic lobectomies performed at our institution from 2010 to 2018. Segmentectomy, pneumonectomy, and lobectomy for other conditions were excluded. Descriptive statistics and Kaplan-Meier survival analysis are presented. Results Pathologic stage distribution was IA in 194 (39%), IB in 54 (11%), IIA in 41 (8%), IIB in 109 (22%), IIIA in 83 (17%), IIIB in 11 (2%), and IV in 8 (2%). Elective conversion occurred in 26 cases (5.2%) and emergent conversion occurred in 3 cases (0.6%). Mean length of stay was 3.7 days (1 to 40). The most common complications encountered were atrial fibrillation in 71 (14.2%) and prolonged air leak in 49 (9.8%). Thirty-day mortality occurred in 3 patients (0.6%). Nodal upstaging was 16.6%. Stage specific overall survival outcomes included an 84% survival for stage IA patients, 73% for IB, 68% for IIA, 63% for IIB, and 49% for IIIA disease. Conclusions Robotic lobectomy for lung cancer is a feasible technique for treatment of non-small cell lung cancer with low perioperative morbidity and mortality. Furthermore, excellent oncologic outcomes can be achieved with this approach.

Prognosis and recurrence patterns in patients with early stage lung cancer: a multi-state model approach

“…Earlier diagnosis leads to a survival gain of 33% and 60% for regional and local cancer stages, respectively ( 3 ). Surgery is the mainstay treatment for early stage NSCLC ( 4 ); however, treatment failure in patients undergoing surgery for early stage NSCLC is quite high (30–55%) ( 5 ). Treatment failure may result in locoregional recurrence and distant metastasis and is the most common cause of death in patients with lung cancer ( 6 ).…”

“…Figure4 Aalen-Johansen estimates of transition probabilities from surgery to surgery, locoregional recurrence, distant metastasis or death in a stacked display format.…”

Approaches and outcomes of Robotic-Assisted Thoracic Surgery (RATS) for lung cancer: a narrative review

“…Nevertheless, conversion rate remains < 10% in recent series, thus at least not higher than VATS [ 37 ]. Reasons for conversion are similar to those described for VATS (e.g., uncontrollable bleeding, extensive adhesions, anatomical reasons, and lymph nodes of complex resection) [ 38 , 42 , 75 – 77 ]. It should be noted that there are several procedures in which robotic systems may even perform better than VATS.…”

“…In a large RATS lobectomy series of 500 cases, Herrera et al reported interesting results: an elective conversion rate of 5%, an emergency conversion rate of 0.6%, and a 30-day mortality of 0.6% [ 42 ]. Most frequent complications were atrial fibrillation (14.2% of cases) and prolonged air leak (9.8% of cases).…”

Adopting the robotic platform for anatomic lung resections: real life lessons for the tech enthusiast

“…Like any new technology, the initial legitimate concerns were focused on safety, as the operating surgeon is physically away from the patient, and achieving oncological outcomes that are comparable to the traditional approaches. The scientific literature over the last 2 decades clearly refuted both concerns, as robotic lung surgery was demonstrated to be safe and to achieve at least similar survival to the open and thoracoscopic [video-assisted thoracoscopic surgery (VATS)] approaches (4,5). Furthermore, the robotic platform allowed many to push the boundaries of minimally invasive surgery and tackle complex lung and chest wall procedures, as well advance stage disease after neoadjuvant treatment (6).…”