Use and Outcomes of Minimally Invasive Lobectomy for Stage I Non-Small Cell Lung Cancer in the National Cancer Data Base

Abstract

Background Previous studies have raised concerns that video-assisted thoracoscopic (VATS) lobectomy may compromise nodal evaluation. The advantages or limitations of robotic lobectomy have not been thoroughly evaluated. Methods Perioperative outcomes and survival of patients who underwent open versus minimally-invasive surgery (MIS [VATS and robotic]) lobectomy and VATS versus robotic lobectomy for clinical T1-2, N0 non-small cell lung cancer from 2010 to 2012 in the National Cancer Data Base were evaluated using propensity score matching. Results Of 30,040 lobectomies, 7,824 were VATS and 2,025 were robotic. After propensity score matching, when compared with the open approach (n = 9,390), MIS (n = 9,390) was found to have increased 30-day readmission rates (5% versus 4%, p < 0.01), shorter median hospital length of stay (5 versus 6 days, p < 0.01), and improved 2-year survival (87% versus 86%, p = 0.04). There were no significant differences in nodal upstaging and 30-day mortality between the two groups. After propensity score matching, when compared with the robotic group (n = 1,938), VATS (n = 1,938) was not significantly different from robotics with regard to nodal upstaging, 30-day mortality, and 2-year survival. Conclusions In this population-based analysis, MIS (VATS and robotic) lobectomy was used in the minority of patients for stage I non-small cell lung cancer. MIS lobectomy was associated with shorter length of hospital stay and was not associated with increased perioperative mortality, compromised nodal evaluation, or reduced short-term survival when compared with the open approach. These results suggest the need for broader implementation of MIS techniques.

Robotic paravertebral schwannoma resection at extreme locations of the thoracic cavity

“…1,15 Minimally invasive video-assisted thoracoscopic surgery (VATS) and, more recently, robot-assisted VATS (da Vinci Surgical System, Intuitive Surgical Inc.) for various intrathoracic procedures, particularly pulmonary lobectomy for lung malignancy, have been unequivocally shown to be superior to open thoracotomy with a significant reduction in postoperative morbidity, mortality, and length of stay, translating into increased cost-effectiveness with similar oncological outcomes. 26 Robotic endoscopic surgery has been widely and successfully adopted by many subspecialties. By virtue of the multiple operating angles of its 4 dexterous robotic arms, 10× optical magnification, and 3D high-resolution imaging, the da Vinci Surgical System allows the surgeon to perform precise dissections from extreme angles, even for a deep target or within a narrow space.…”

Robotic lobectomy: revolution or evolution?

“…Evaluating 8,253 RATS lobectomies in the Healthcare Cost and Utilization Project National Inpatient Sample, Tchouta et al found that high-volume centers had a shorter LOS and decreased mortality (15). Yang et al evaluated 30,040 lobectomies for stage I lung carcinoma (7,824 VATS and 2,025 RATS) in the National Cancer Database and found that MIS approaches were associated with increased 30-day readmission but shorter LOS and improved 2-year survival (16).…”

Surgical treatment for early stage non-small cell lung cancer

“…Long-term overall and disease-free survival, however, have not been reported by these studies. Other studies have demonstrated no significant difference in upstaging between the two techniques (18)(19)(20). (23)(24)(25)(26).…”