Minimally invasive (robotic assisted thoracic surgery and video-assisted thoracic surgery) lobectomy for the treatment of locally advanced non-small cell lung cancer

Abstract

Background: Insufficient data exist on the results of minimally invasive surgery (MIS) for locally advanced non-small cell lung cancer (NSCLC) traditionally approached by thoracotomy. The use of telerobotic surgical systems may allow for greater utilization of MIS approaches to locally advanced disease. We will review the existing literature on MIS for locally advanced disease and briefly report on the results of a recent study conducted at our institution. Methods: We performed a retrospective review of a prospective single institution database to identify patients with clinical stage II and IIIA NSCLC who underwent lobectomy following induction chemotherapy. The patients were classified into two groups (MIS and thoracotomy) and were compared for differences in outcomes and survival. Results: From January 2002 to December 2013, 428 patients {397 thoracotomy, 31 MIS [17 robotic and 14 video-assisted thoracic surgery (VATS)]} underwent induction chemotherapy followed by lobectomy. The conversion rate in the MIS group was 26% (8/31) The R0 resection rate was similar between the groups (97% for MIS vs. 94% for thoracotomy; P=0.71), as was postoperative morbidity (32% for MIS vs. 33% for thoracotomy; P=0.99). The median length of hospital stay was shorter in the MIS group (4 vs. 5 days; P<0.001). The 3-year overall survival (OS) was 48.3% in the MIS group and 56.6% in the thoracotomy group (P=0.84); the corresponding 3-year DFS were 49.0% and 42.1% (P=0.19). Conclusions: In appropriately selected patients with NSCLC, MIS approaches to lobectomy following induction therapy are feasible and associated with similar disease-free and OS to those following thoracotomy.

Similar results of robotic and uniportal videothoracoscopic surgery for lung cancer treatment

“…While we agree with the conclusion of the article by Yang et al (1) that the two minimally invasive surgical techniques are feasible and safe for NSCLC treatment, we expect that more advantages of the robotic approach will be underlined when robotic and video-assisted approaches will be compared in treatment of more complex cases, such as difficult segments or advanced disease after chemotherapy or radiotherapy (10). The extension of indication of manual minimally invasive surgery (M-MIS) in case of locally advanced N2 disease is not obvious as stated in the consensus paper on indication of VATS (11).…”

Lobectomy for non-small cell lung carcinoma: a nationwide study of short- and long-term survival

“…During the last period, adjuvant chemotherapy was offered to all patients at stage IIIA, as recommended by the European Society for Medical Oncology (ESMO) guidelines [7]. The 3-year survival for stages II and IIIA together was 49% in the present study, as compared to 56.6% in a newly published study by Park et al [23], where all the patients received induction therapy. In our study, very few of the patients had induction therapy.…”

Should primary tumor be resected for non-small cell lung cancer with malignant pleural disease unexpectedly found during operation?—a systemic review and meta-analysis

“…Even if Sugarbaker et al (20) proved that pleuropneumonectomy to be a safe choice for cancers involves an ipsilateral pleura, it was still relevant to a perioperative mortality of 4.6%. Until the first application of video-assisted thoracic surgery (VATS) lobectomy in early 1990s (21,22), more and more evidence demonstrated that VATS lobectomy might be an alternative approach, which concerning with less intraoperative bleeding, less trauma, reduced postoperative pain, shorter hospitalization days (23)(24)(25)(26)(27)(28)(29), and these aspects all improved survival indirectly. Consequently, the survival outcomes of VATS were still to be explored.…”