Kavian Toosi1, Frank O Velez-Cubian2, Jessica Glover1, Emily P Ng1, Carla C Moodie3, Joseph R Garrett3, Jacques P Fontaine4, Eric M Toloza5. 1. Morsani College of Medicine, Tampa, FL. 2. Department of Surgery, University of South Florida, Tampa, FL. 3. Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL. 4. Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL; Department of Surgery, University of South Florida, Tampa, FL; Department of Oncologic Sciences, University of South Florida, Tampa, FL. 5. Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL; Department of Surgery, University of South Florida, Tampa, FL; Department of Oncologic Sciences, University of South Florida, Tampa, FL. Electronic address: eric.toloza@moffitt.org.
Abstract
BACKGROUND: Mediastinal involvement in resected non-small-cell lung cancer mandates adjuvant therapy and affects survival. This study investigated lymph node dissection efficacy, lymph node metastasis detection, and survival after robotic-assisted lobectomy for non-small-cell lung cancer. METHODS: We retrospectively analyzed patients who underwent robotic-assisted lobectomy for non-small-cell lung cancer. Survival was assessed through chart reviews, Social Security Death Registry, and national obituary searches. Kaplan-Meier survival curves by clinical and pathologic stage were compared by log-rank and Cox regression analysis. RESULTS: In 249 patients (mean age, 67.8 ± 0.6 years), mean individual mediastinal lymph nodes retrieved was 7.7 ± 0.3 lymph nodes, with mean of 13.9 ± 0.4 N1+ mediastinal lymph nodes. There were 159 (63.9%) clinical stage I versus 134 (53.8%) pathologic stage I patients, with 67 (26.9%) patients upstaged (20 cN0 to pN1; 17 cN0 to pN2; 4 cN1 to pN2) and 37 (14.9%) downstaged. One-year and 3-year survival rates, respectively, changed between clinical stage I (clinical stage I, 91% and 70%; clinical stage II, 80% and 64%; clinical stage III, 78% and 57%; clinical stage IV, 71% and 45%) and pathologic stage (pathologic stage I, 92% and 75%; clinical stage II, 83% and 73%; pathologic stage III, 75% and 44%; and pathologic stage IV, 67% and 0%). CONCLUSION: Mediastinal lymph node dissection during robotic-assisted lobectomy adequately assesses lymph node stations and detects occult lymph node metastasis. Stage-specific survival is affected by upstaging.
BACKGROUND: Mediastinal involvement in resected non-small-cell lung cancer mandates adjuvant therapy and affects survival. This study investigated lymph node dissection efficacy, lymph node metastasis detection, and survival after robotic-assisted lobectomy for non-small-cell lung cancer. METHODS: We retrospectively analyzed patients who underwent robotic-assisted lobectomy for non-small-cell lung cancer. Survival was assessed through chart reviews, Social Security Death Registry, and national obituary searches. Kaplan-Meier survival curves by clinical and pathologic stage were compared by log-rank and Cox regression analysis. RESULTS: In 249 patients (mean age, 67.8 ± 0.6 years), mean individual mediastinal lymph nodes retrieved was 7.7 ± 0.3 lymph nodes, with mean of 13.9 ± 0.4 N1+ mediastinal lymph nodes. There were 159 (63.9%) clinical stage I versus 134 (53.8%) pathologic stage I patients, with 67 (26.9%) patients upstaged (20 cN0 to pN1; 17 cN0 to pN2; 4 cN1 to pN2) and 37 (14.9%) downstaged. One-year and 3-year survival rates, respectively, changed between clinical stage I (clinical stage I, 91% and 70%; clinical stage II, 80% and 64%; clinical stage III, 78% and 57%; clinical stage IV, 71% and 45%) and pathologic stage (pathologic stage I, 92% and 75%; clinical stage II, 83% and 73%; pathologic stage III, 75% and 44%; and pathologic stage IV, 67% and 0%). CONCLUSION: Mediastinal lymph node dissection during robotic-assisted lobectomy adequately assesses lymph node stations and detects occult lymph node metastasis. Stage-specific survival is affected by upstaging.
Authors: Monica Casiraghi; Alessio Vincenzo Mariolo; Shehab Mohamed; Giulia Sedda; Patrick Maisonneuve; Antonio Mazzella; Giorgio Lo Iacono; Francesco Petrella; Lorenzo Spaggiari Journal: J Clin Med Date: 2022-06-11 Impact factor: 4.964