Chi-Fu Jeffrey Yang1, Zhifei Sun1, Paul J Speicher1, Shakir M Saud2, Brian C Gulack1, Matthew G Hartwig1, David H Harpole1, Mark W Onaitis1, Betty C Tong1, Thomas A D'Amico1, Mark F Berry3. 1. Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina. 2. Department of Cell Biology and Molecular Medicine, New Jersey Medical School, Newark, New Jersey. 3. Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina; Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California. Electronic address: berry037@stanford.edu.
Abstract
BACKGROUND: Previous studies have raised concerns that video-assisted thoracoscopic (VATS) lobectomy may compromise nodal evaluation. The advantages or limitations of robotic lobectomy have not been thoroughly evaluated. METHODS: Perioperative outcomes and survival of patients who underwent open versus minimally-invasive surgery (MIS [VATS and robotic]) lobectomy and VATS versus robotic lobectomy for clinical T1-2, N0 non-small cell lung cancer from 2010 to 2012 in the National Cancer Data Base were evaluated using propensity score matching. RESULTS: Of 30,040 lobectomies, 7,824 were VATS and 2,025 were robotic. After propensity score matching, when compared with the open approach (n = 9,390), MIS (n = 9,390) was found to have increased 30-day readmission rates (5% versus 4%, p < 0.01), shorter median hospital length of stay (5 versus 6 days, p < 0.01), and improved 2-year survival (87% versus 86%, p = 0.04). There were no significant differences in nodal upstaging and 30-day mortality between the two groups. After propensity score matching, when compared with the robotic group (n = 1,938), VATS (n = 1,938) was not significantly different from robotics with regard to nodal upstaging, 30-day mortality, and 2-year survival. CONCLUSIONS: In this population-based analysis, MIS (VATS and robotic) lobectomy was used in the minority of patients for stage I non-small cell lung cancer. MIS lobectomy was associated with shorter length of hospital stay and was not associated with increased perioperative mortality, compromised nodal evaluation, or reduced short-term survival when compared with the open approach. These results suggest the need for broader implementation of MIS techniques.
BACKGROUND: Previous studies have raised concerns that video-assisted thoracoscopic (VATS) lobectomy may compromise nodal evaluation. The advantages or limitations of robotic lobectomy have not been thoroughly evaluated. METHODS: Perioperative outcomes and survival of patients who underwent open versus minimally-invasive surgery (MIS [VATS and robotic]) lobectomy and VATS versus robotic lobectomy for clinical T1-2, N0 non-small cell lung cancer from 2010 to 2012 in the National Cancer Data Base were evaluated using propensity score matching. RESULTS: Of 30,040 lobectomies, 7,824 were VATS and 2,025 were robotic. After propensity score matching, when compared with the open approach (n = 9,390), MIS (n = 9,390) was found to have increased 30-day readmission rates (5% versus 4%, p < 0.01), shorter median hospital length of stay (5 versus 6 days, p < 0.01), and improved 2-year survival (87% versus 86%, p = 0.04). There were no significant differences in nodal upstaging and 30-day mortality between the two groups. After propensity score matching, when compared with the robotic group (n = 1,938), VATS (n = 1,938) was not significantly different from robotics with regard to nodal upstaging, 30-day mortality, and 2-year survival. CONCLUSIONS: In this population-based analysis, MIS (VATS and robotic) lobectomy was used in the minority of patients for stage I non-small cell lung cancer. MIS lobectomy was associated with shorter length of hospital stay and was not associated with increased perioperative mortality, compromised nodal evaluation, or reduced short-term survival when compared with the open approach. These results suggest the need for broader implementation of MIS techniques.
Authors: Bryan M Burt; Andrzej S Kosinski; Joseph B Shrager; Mark W Onaitis; Tracey Weigel Journal: J Thorac Cardiovasc Surg Date: 2014-03-13 Impact factor: 5.209
Authors: Scott J Swanson; Daniel L Miller; Robert Joseph McKenna; John Howington; M Blair Marshall; Andrew C Yoo; Matthew Moore; Candace L Gunnarsson; Bryan F Meyers Journal: J Thorac Cardiovasc Surg Date: 2013-11-08 Impact factor: 5.209
Authors: Michael Kent; Thomas Wang; Richard Whyte; Thomas Curran; Raja Flores; Sidhu Gangadharan Journal: Ann Thorac Surg Date: 2013-10-01 Impact factor: 4.330
Authors: Daniel J Boffa; Andrzej S Kosinski; Subroto Paul; John D Mitchell; Mark Onaitis Journal: Ann Thorac Surg Date: 2012-06-27 Impact factor: 4.330
Authors: Norma E Farrow; Selena J An; Paul J Speicher; David H Harpole; Thomas A D'Amico; Jacob A Klapper; Matthew G Hartwig; Betty C Tong Journal: J Thorac Cardiovasc Surg Date: 2019-11-13 Impact factor: 5.209
Authors: Rachel L Medbery; Theresa W Gillespie; Yuan Liu; Dana C Nickleach; Joseph Lipscomb; Manu S Sancheti; Allan Pickens; Seth D Force; Felix G Fernandez Journal: Ann Thorac Surg Date: 2016-07-29 Impact factor: 4.330
Authors: Nicole Ezer; Minal Kale; Keith Sigel; Sameer Lakha; Grace Mhango; Emily Goodman; Daniel Nicastri; Scott Swanson; Alfred Neugut; Juan P Wisnivesky Journal: Ann Am Thorac Soc Date: 2018-01