Robotic lobectomy for non–small cell lung cancer (NSCLC): Long-term oncologic results

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 143; no. 2; pp. 383 - 389
• Main Authors: Park, Bernard J., MD, Melfi, Franca, MD, Mussi, Alfredo, MD, Maisonneuve, Patrick, DipEng, Spaggiari, Lorenzo, MD, Da Silva, Ruy Kuenzer Caetano, MD, Veronesi, Giulia, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2012; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Cardiology. Vascular system; Cardiothoracic Surgery; Female; Hospital Mortality; Humans; Italy; Kaplan-Meier Estimate; Length of Stay; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Medical sciences; Middle Aged; Neoplasm Staging; Pneumology; Pneumonectomy - adverse effects; Pneumonectomy - methods; Pneumonectomy - mortality; Retrospective Studies; Robotics; Surgery, Computer-Assisted - adverse effects; Surgery, Computer-Assisted - mortality; Survival Rate; Thoracic Surgery, Video-Assisted - adverse effects; Thoracic Surgery, Video-Assisted - mortality; Time Factors; Treatment Outcome; Tumors of the respiratory system and mediastinum; Italy; computed tomography; CT; 10.4; VATS; NSCLC; 28; CALGB; video-assisted thoracic surgery; non–small cell lung cancer; Cancer and Leukemia Group B; 10; Lung disease; Prognosis; Respiratory disease; Malignant tumor; non-small cell lung carcinoma; Long term; Robotics; Treatment; Surgery; Bronchus disease; Anesthesia; Circulatory system; Cardiology; Lobectomy; Cancer; Non small cell carcinoma
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2011.10.055

Objective(s) We evaluated a large series of patients undergoing robotic lobectomy for the treatment of early-stage non–small cell lung cancer (NSCLC) to assess long-term oncologic efficacy. Methods A multi-institutional retrospective review of patients undergoing robotic lobectomy for NSCLC was performed. Robotic lobectomy was performed in a manner consistent with the Cancer and Leukemia Group B (CALGB) consensus video-assisted thoracic surgery (VATS) lobectomy technique using a robotic surgical system. Perioperative outcomes and long-term follow-up were recorded prospectively, and survival was calculated from the date of surgery to last follow-up. Results From November 2002 through May 2010, a total of 325 consecutive patients underwent robotic lobectomy for early-stage NSCLC at 3 institutions. The median age of patients was 66 years (range, 30-87 years), and 37% (120) were female. The majority were in clinical stage I (IA, 247; IB, 63). Conversion rate to thoracotomy was 8% (27/325). Overall morbidity rate was 25.2% (82/325), and major complication rate was 3.7% (12/325). There was 1 in-hospital death (0.3%), and the median length of stay was 5 days (range, 2-28 days). Pathologic stage distribution was 54% (176) IA, 22% (72) IB, 13% (41) IIA, 5% (15) IIB, and 6% (21) IIIA. With a median follow-up of 27 months, overall 5-year survival was 80% (95% confidence intervals [CI] = 73-88), and by pathologic stage, 91% (CI = 83-99) for stage IA, 88% (CI = 77-98) for stage IB, and 49% (CI = 24-74) for all patients with stage II disease. Overall 3-year survival for patients with stage IIIA disease was 43% (CI = 16-69). Conclusions Robotic lobectomy for early-stage NSCLC can be performed with low morbidity and mortality. Long-term stage-specific survival is acceptable and consistent with prior results for VATS and thoracotomy.