R. Gerard2, D. Nguyen2, F. Velez-Cubian2, C. Moodie1, J. Garrett1, J. Fontaine1,2, E. Toloza1,2 1Moffitt Cancer Center And Research Institute,Tampa, FL, USA 2University Of South Florida College Of Medicine,Tampa, FL, USA
Introduction: We sought to evaluate both short- and long-term postoperative outcomes between patients with continuous nodal metastasis (NoSkip) compared to those with nodal skip-metastasis (Skip).
Method: We retrospectively analyzed patients who underwent robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy by one surgeon between September 2010 and May 2017. Patients with final pathology reporting pulmonary metastasis or benign lesion were excluded. Inclusion criteria consisted of obligatory pathologic mediastinal nodal (pN2) classification. Patients were then stratified into two groups: Skip or NoSkip. Patients’ demographics, perioperative outcomes, perioperative complications, and overall survival (OS) were compared.
Results: Of a total of 423 patients who underwent RAVT lobectomy, 390 patients had non-small cell lung cancer (NSCLC). While 319 patients with NSCLC were pN0 or pN1, 71 patients had pN2 disease, of which 18 (25.3%) were Skip and 53 (74.7%) were NoSkip. Mean age, gender distribution, and body habitus were similar between groups (p=0.617, p=0.194 and p=0.091, respectively). Patients with Skip had lower mean pre-operative forced expiratory volume in 1 second as percent of predicted (FEV1%; 79.5±3.5% vs. 89.7±2.8%), but this difference was not quite significant (p=0.053). Albeit not significant, patients in the NoSkip group had slightly more intraoperative complications (15.1% vs. 5.6%) and slightly more often required conversion to thoracotomy (15.1% vs. 5.6%) compared to the Skip group (p=0.293 and p=0.293, respectively). Incidence of postoperative complications were similar between groups (p>0.05). Patients in both groups had similar median estimated blood loss (EBL; 200 mL vs. 200 mL), operative time (214.5 min vs. 197 min), chest tube duration (4.5 d vs. 4 d), and hospital length of stay (LOS; 5 d vs. 5 d) (p=0.734, p=0.178 and p=0.973, respectively). Mean number of N1 lymph node (LN) stations reported and mean number of N1 LNs evaluated were similar between groups (1.9±0.1 vs. 1.7±0.1 [p=0.226] and 7.6±0.6 vs. 6.7±0.6 [p=0.441], respectively). Mean number of N2 LN stations reported and mean number of N2 LNs evaluated were also similar between groups (3.7±0.0 vs. 3.4±0.2 and 11.4±1.1 vs. 9.4±1.4, respectively). Patients with nodal skip metastasis (Skip group) had slightly less favorable 1-yr (50.7%±13.8% vs. 80.0%±6.4%) and 3-yr OS (42.2%± 13.9% vs. 57.1%±9.2%) (p=0.077).
Conclusion: Mean patient age, gender distribution, and body habitus did not differ between groups. Patients with Skip had reduced FEV1% pre-operatively, but the number of postoperative complications remained similar between groups. No significant differences were noted in EBL, operative times, chest tube duration, and hospital LOS. Skip is associated with worse OS compared to patients with NoSkip.