Nodal Upstaging Evaluation After Robotic-Assisted Lobectomy for Early-Stage Non-small Cell Lung Cancer Compared to Video-Assisted Thoracic Surgery and Thoracotomy: A Retrospective Single Center Analysis

Abstract

Introduction: The standard surgical procedures for patients with early-stage NSCLC is lobectomy-associated radical lymphadenectomy performed by using the thoracotomy approach. In the last few years, minimally invasive techniques have increasingly strengthened their role in lung cancer treatment, especially in the early stage of the disease. Although the lobectomy technique has been accepted, controversy still surrounds lymph node dissection. In our study, we analyze the rate of upstaging early non-small cell lung cancer patients who underwent radical surgical treatment using the robotic and the VATS techniques compared to the standard thoracotomy approach.Methods and Materials: We retrospectively reviewed patients who underwent a lobectomy and radical lymphadenectomy at our Institute between 2010 and 2019. We selected 505 patients who met the inclusion criteria of the study: 237 patients underwent robotic surgery, 158 patients had thoracotomy, and 110 patients were treated with VATS. We analyzed the demographic features between the groups as well as the nodal upstaging rate after pathological examination, the number of dissected lymph nodes and the ratio of dissected lymph nodes to metastatic lymph nodes of the three groups.Results: The patients of the three groups were homogenous with respect to age, sex, and histology. The postoperative major morbidity rate was significantly higher in the thoracotomy group, and hospital stay was significantly longer. The percentage of the mediastinal nodal upstaging rate and the number of dissected lymph nodes was significantly higher in the robotic group compared with the VATS group. The ratio of dissected lymph nodes to metastatic lymph nodes was significantly lower compared with the VATS group and the thoracotomy group.Discussion: The prognostic impact of the R(un) status is still highly debated. A surgical approach that allows better results in terms of resection has still not been defined. Our results show that robotic surgery is a safe and feasible approach especially regarding the accuracy of mediastinal lymphadenectomy. These findings can lead to defining a more precise pathological stage of the disease and, if necessary, to more accurate postoperative treatment.

Propensity score-matched comparison of robotic- and video-assisted thoracoscopic surgery, and open lobectomy for non-small cell lung cancer patients aged 75 years or older

“…In our hospital, mediastinal LNs were systemically assessed by using thoracic CT and PET-CT, and invasive approaches including EBUS-TBNA and mediastinoscopy were further applied when necessary to minimize the incidence of occult N2 disease. Moreover, in our study, the incidence of occult N2 disease in RATS, VATS, and OL groups was 4.12%, 4.12%, and 8.25%, respectively, which was consistent with many previous studies (11,32,(37)(38)(39)(40). Our results also showed that the three groups had comparable incidences of postoperative lymph nodal upstaging.…”

Implementing a pediatric robotic surgery program: future perspectives

“…The robotic thoracic approach is in full development, with clear indications for resection in lung cancer (37) , and even the esophageal approach has been internationally agreed upon (38) . In 2020, Durand et al (39) published the first study of robotic lobectomy in seven pediatric patients.…”

Inflammatory cytokines in robot-assisted thoracic surgery versus video-assisted thoracic surgery

“…The more precise dissection afforded by the improved 3-dimensional visualization with the robot may be associated with less tissue trauma and less cytokine release. Similarly, it has been argued that the robotic-assisted thoracic surgery (RATS) approach is associated with a more complete lymphadenectomy and thus potentially reduced oncologic burden, which may not only be associated with a lesser inflammatory state, but also a reduced recurrence rate, however, data regarding this phenomenon is not yet conclusive (4,(14)(15)(16)(17)(18)(19)(20).…”