MTP4-01: Small cell lung cancer

Abstract

technical aspects of incorporating robotic assistance and the perioperative outcomes. MethodsPatients with adequate cardiopulmonary reserve to tolerate lobectomy for clinical stage I NSCLC or other pathologic tumors that were peripheral and confined to the lung were considered eligible for VATS lobectomy. At our institution the procedure is performed using two 1 -1.5 cm access incisions and a ≤ 4 cm non-rib-spreading utility incision with intrathoracic visualization achieved via thoracoscope exclusively. Initial thoracic exploration is conducted with conventional thoracoscopy in order to verify resectability and to establish the three standard VATS lobectomy access incisions. Once the incisions have been made, the da Vinci ® robot is brought into position, the surgical instruments are introduced under direct thoracoscopic vision, and the operating surgeon moves to the surgeonís console. Robotic assistance is defined as use of the da Vinci ® Surgical System during a VATS lobectomy for individual dissection, isolation, and ligation of the pulmonary hilar structures, as well as mediastinal lymph node dissection. Informed consent for robotic assistance during VATS lobectomy was obtained. Data on patient characteristics, operative details and postoperative recovery were collected in a prospective database approved by the institutional review board and analyzed retrospectively. All complications were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 (CT-CAE 3.0)(http://ctep.cancer.gov/reporting/ctc.html). ResultsBetween November 2002 and May 2006 there were 63 consecutive patients who underwent attempted robotic-assisted VATS lobectomy employing the da Vinci ® Surgical System. The patient characteristics are listed in the Table . Most of the lesions were located in the upper lobes (44/63, 70%) with right upper lobe tumors being the most common (28). The vast majority of our patients had NSCLC (60/63, 95%), two patients had typical carcinoid tumors, and one had a primary pulmonary lymphoma. Those with NSCLC all were clinical stage IA preoperatively. Eleven patients (17%) had no tissue diagnosis and underwent initial VATS and wedge resection in the same setting. VATS lobectomy using robotic assistance was completed in 58 (92%) patients. Conversion to thoracotomy was required in 5 patients (8%). Three patients were converted for minor bleeding, two from cautery injuries to a segmental pulmonary artery in the course of dissection and one during isolation of the superior pulmonary vein. None of these patients required blood transfusion intraoperatively or postoperatively. One patient required conversion secondary to loss of single lung isolation and one underwent thoracotomy for excessive adhesions and inflammatory nodal disease. The Table shows the perioperative results. Median total operative time was 284 minutes (range 185 -460). Median intrathoracic operative time was 210 minutes (range 143 -350). Of note, the median total and intrathoracic operative time for th...