Oncological Outcomes of Robotic Lobectomy and Radical Lymphadenectomy for Early-Stage Non-Small Cell Lung Cancer

Abstract

Background: While the thoracotomy approach was considered the gold standard until two decades ago, robotic surgery has increasingly strengthened its role in lung cancer treatment, improving patients’ peri-operative outcomes. In this study, we report our experience in robotic lobectomy for early-stage non-small cell lung cancer, with particular attention to oncological outcomes and nodal upstaging rate. Methods: We retrospectively reviewed patients who underwent lobectomy and radical lymphadenectomy at our Institute between 2016 and 2020. We selected 299 patients who met the inclusion criteria of the study. We analyzed the demographic features of the groups as well as their nodal upstaging rate after pathological examination. Then, we analyzed disease-free and overall survival of the entire enrolled patient population and we compared the same oncological outcomes in the upstaging and the non-upstaging group. Results: A total of 299 patients who underwent robotic lobectomy were enrolled. After surgery, 55 patients reported nodal hilar or mediastinal upstaging. The 3-year overall survival of the entire population was 82.8%. The upstaging group and the non-upstaging group were homogeneous for age, gender, smoking habits, clinical stage, tumor site, tumor histology. The non-upstaging group had better OS (p = 0.004) and DFS (p < 0.0001). Conclusion: Our results show that robotic surgery is a safe and feasible approach for the treatment of early-stage NSCLC, especially for its accuracy in mediastinal lymphadenectomy. The oncological outcomes were encouraging and consistent with previous findings.

Perioperative outcomes of robotic lobectomy for early-stage non-small cell lung cancer in elderly patients

“…Minimally invasive thoracic surgery, particularly robotic surgery, is thought to reduce surgical stress and postoperative complications still pursuing a radical intended pulmonary resection ( 12 , 25 ). In the elderly, robotic pulmonary lobectomy complications rate was demonstrated to be lower than that in open surgery but similar to that in video-assisted thoracic surgery with an overall incidence approximately 30% ( 10 , 11 ).…”

“…In the context of minimally invasive surgery, robotic surgery is outgrowing thanks to its ability to enhance surgical maneuverability and visualization ( 12 ). Nonetheless, robotic surgery is demonstrated to improve oncological outcomes with a complication and conversion rate comparable to video-assisted surgery ( 13 ).…”

Fluorescence-guided lung nodule identification during minimally invasive lung resections

“…Minimally invasive thoracic surgery is now the new paradigm in the treatment of Non-Small Cells Lung Cancer (NSCLC) ( 3 , 4 ). Video-thoracoscopic and robotic approaches have demonstrated better perioperative outcomes compared with the open approach.…”

CT‐guided indocyanine green and lipiodol marking of ground glass opacity before robotic‐assisted lung resection

“…In the last few years, given the spreading of robotic surgery for the treatment of early stage non-small cell lung cancer, the identification of the lung nodules, especially GGOs, that do not surface on the visceral pleura could be challenging. 2 The author well reported the main techniques to mark the lesions using a single tracer. We want report a case of our CT-guided technique of lung nodule marking using a mixture of indocyanine green (ICG) and lipiodol that could be useful during robotic surgery.…”