P. J. Kneuertz1, D. M. D’Souza1, S. D. Moffatt-Bruce1, R. E. Merritt1 1The Ohio State University Wexner Medical Center,Department Of Surgery,Columbus, OH, USA
Introduction:
Patients with poor pulmonary function have a high risk for pulmonary complications following lobectomy. Robotic lobectomy is currently the least invasive approach. We hypothesized that robotic lobectomy may be of particular benefit in high-risk patients.
Methods:
We reviewed our institutional Society of Thoracic Surgeons (STS) data on 762 lobectomy patients from 2012 to 2017. High-risk patients were identified by pulmonary function test [FEV1 (forced expiratory volume in 1 second) <60% or DLCO (diffusion capacity of the lung to carbon dioxide) <60% predicted]. Preoperative characteristics and perioperative outcomes were compared between robotic and open lobectomy. Risk of pulmonary complication was assessed by binary logistic regression analysis.
Results:
A total of 190 high risk patients underwent lobectomy by robotic (n= 83), and by open (n=107) procedure. The robotic group included more patients with age >75 years (Robotic 22%, vs. Open 11%, p=0.05), patients with COPD (81% vs. 54%, p=0.001) and active smokers (46% vs. 31%, p=0.04). Robotic lobectomy patients had a lower rate of prolonged air leak >5 days (5% vs. 15%, p=0.02), less atelectasis requiring bronchoscopy (7% vs. 22%, p=0.02), and shorter length of stay (4 vs.7 days, p=0.001). The observed difference in overall pulmonary complication rate between robotic and open lobectomy patients was greatest in high risk patients, and less in intermediate or low risk patients (Figure). No significant difference was seen in the rate of major complications (19% vs. 24%, p=0.4), or 30 day mortality (1.2% vs. 1.9%, p=0.6) following robotic and open lobectomy, respectively. On multivariate analysis, when adjusting for age, FEV1, DCLO, COPD, Zubrod score and prior chest surgery, robotic approach remained independently associated with decreased pulmonary complications (HR 0.58, 95% CI[0.38-0.88] , p=0.005).
Conclusion:
Robotic lobectomy may decrease the risk of pulmonary complication as compared with thoracotomy in high risk patients. Patients with limited pulmonary function derive the most benefit from a robotic approach.
