B. Montane4, F. O. Velez-Cubian2, K. Toosi4, R. Gerard4, C. C. Moodie1, J. R. Garrett1, J. P. Fontaine1,2,3, E. M. Toloza1,2,3 1Moffitt Cancer Center,Thoracic Oncology,Tampa, FL, USA 2University Of South Florida Morsani College Of Medicine,Surgery,Tampa, FL, USA 3University Of Sough Florida College Of Medicine,Oncologic Sciences,Tampa, FL, USA 4University Of South Florida,Morsani College Of Medicine,Tampa, FL, USA
Introduction: Surgical resection is still the gold standard for early stages of primary lung cancers. More advanced stages, including nodal involvement, are approached with a multimodality therapy. The purpose of our investigation was to determine the surgical outcomes of robotic-assisted video-thoracoscopic (RAVT) surgery for early versus late primary lung cancer stages.
Methods: We retrospectively analyzed perioperative outcomes of consecutive patients with primary lung cancer and who underwent RAVT lobectomy by one surgeon at our institution during a 6-year period. Patients were grouped by pathologic stage (pStage) into 4 groups: pStage1, pStage2, pStage3, and pStage4. Patient characteristics, operative times, intraoperative estimated blood loss (EBL), lymph node (LN) dissection, perioperative complications, chest tube duration, hospital length of stay (LOS), and in-hospital mortality were compared among the pStage groups. Chi-square test, Student’s t-test, and Kruskal-Wallis or Mood’s median test were used, with p≤0.05 as significant.
Results: A total of 359 patients underwent RAVT lobectomy by one surgeon between September 2010 and May 2016. Thirty-one patients had pulmonary metastases or benign lesions and were excluded. A cohort of 328 patients was analyzed in our study. Patients’ characteristics differed only by pStage4 having lower body mass index (BMI; p=0.04). Neither overall intraoperative complications nor conversion to open lobectomy differed among pStage groups (p≥0.09), although recurrent laryngeal nerve injury was highest in pStage3 (p=0.02). Overall postoperative complications did not differ among pStage groups (p≥0.18), with the most common postoperative complication being prolonged air leak >5 days (20.5% vs. 19.4% vs. 25.0% vs. 44.4%, respectively, for pStage1 through pStage4; p=0.57). Median EBL and median operative times were lowest for pStage1 (150 mL, p<0.001, and 162 min, p<0.001, respectively), but chest tube duration, hospital LOS, and in-hospital mortality did not differ among pStage groups (p≥0.15). Efficacy of LN dissection was best for pStage2 and pStage3 for numbers of individual N1 (p≤0.02) and N2 (p≤0.002) LNs harvested, respectively, but did not differ among pStage groups for numbers of LN stations assessed (p≥0.16).
Conclusions: Robotic-assisted lobectomy is feasible not only for early stages, but also as part of multi-modality treatment for more advanced primary lung cancers. More advanced pStage, particularly LN involvement, resulted in increased EBL and longer operative times, but did not result in increased perioperative complication risk, hospital LOS, or in-hospital mortality. Robotic-assisted lobectomy should be considered for the surgical component for multi-modality treatment of resectable advanced-stage primary lung cancers.