R. Gerard4, F. O. Velez-Cubian2, E. P. Ng4, 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 South Florida Morsani College Of Medicine,Oncologic Sciences,Tampa, FL, USA 4University Of South Florida,Morsani College Of Medicine,Tampa, FL, USA
Introduction: Tumor size is one factor that determines whether lobectomy is performed via open or minimally invasive approach. We investigated whether tumor size affects perioperative outcomes after robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy.
Methods: We retrospectively studied all patients (pts) who underwent RAVT pulmonary lobectomy between September 2010 and May 2016 by one surgeon at our institution. Patients were grouped by greatest tumor diameter on pathologic measurement of lobectomy specimens. Perioperative outcomes, including estimated blood loss (EBL), skin-to-skin operative time, conversion to open lobectomy, intraoperative and postoperative complications, chest tube duration, hospital length of stay (LOS), and in-hospital mortality were compared. Chi-square test, Student’s t-test, and Kruskal-Wallis test were used, with p≤0.05 as significant.
Results: We identified and grouped 359 pts by greatest tumor diameter being ≤10mm, 11-20mm, 21-30mm, 31-50mm, or ≥51mm. Tumor histology was comprised of NSCLC (89.4%), SCLC (1.9%), and pulmonary metastases (8.6%), with the most common NSCLC histology being adenocarcinoma (63.8%), squamous cell (21.5%), and neuroendocrine (9.7%). No differences were noted in mean age, female:male ratio, or mean body surface area among the groups, but mean body mass index was lowest in pts with tumors ≥51mm. Lobar distribution of lung tumors did not differ among the groups (p>0.14), but extent of resection differed by pts with tumors ≥51mm having a lower rate of simple lobectomies (p<0.001) and a higher rate of en bloc chest wall resection (p<0.001). Neither overall intraoperative complications nor overall or emergent conversion to open lobectomy differed among the groups (p>0.21), but pulmonary artery (PA) injury occurred in as high as 7.2% of pts in groups with tumors ≥21mm (p=0.014). While median EBL was higher in pts with tumors ≥51mm (p≤0.003) and median operative time was higher in pts within groups with tumors ≥31mm (p≤0.019), median chest tube duration and median hospital LOS did not differ among the groups (p>0.37). Neither overall total postoperative complications nor overall pulmonary or cardiovascular complications differed among the groups (p>0.23), but pneumothorax after chest tube removal and requiring intervention was more frequent in pts who had tumors ≤10mm (p=0.03). In-hospital mortality did not differ among the groups (p=0.60).
Conclusions: Patients who undergo RAVT lobectomy for tumors ≥51mm are associated with lower BMI and are less likely to have simple lobectomies and more likely to require en bloc chest wall resection. Patients with larger tumors also are at increased risk of PA injury, higher EBL, and longer operative times, but are at lower risk for pneumothorax after chest tube removal and that require intervention. However, tumor size does not affect chest tube duration, hospital LOS, or in-hospital mortality.