Giulia Veronesi1, Bernard Park2, Robert Cerfolio3, Mark Dylewski4, Alpert Toker5, Jacques P Fontaine6,7,8, Wael C Hanna9,10, Emanuela Morenghi11,12, Pierluigi Novellis1, Frank O Velez-Cubian7, Marisa H Amaral6, Elisa Dieci1, Marco Alloisio1,12, Eric M Toloza6,7,8. 1. Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy. 2. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 3. Thoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. 4. Department of Cardiothoracic Surgery, Baptist Health South Florida-South Miami Hospital, South Miami, FL, USA. 5. Department of Thoracic Surgery, Group Florence Nightingale Hospitals, Istanbul, Turkey. 6. Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA. 7. Department of Surgery, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA. 8. Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA. 9. Department of Surgery, Division of Thoracic Surgery, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada. 10. Department of Surgery, McMaster University, Hamilton, ON, Canada. 11. Biostatistics Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy. 12. Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy.
Abstract
OBJECTIVES: Minimally invasive surgery is accepted for early-stage lung cancer, but its role in locally advanced disease is controversial, especially using a robotic platform. The aim of this retrospective study was to assess the safety and effectiveness of robot-assisted resection in patients with Stage IIIA non-small-cell lung cancer (NSCLC) or carcinoid tumours in the series as a whole and in different subgroups according to adjuvant treatment. METHODS: This was a retrospective multicentre study of consecutive patients with clinically evident or occult N2 disease (210 NSCLC and 13 carcinoid) who, in 2007-2016, underwent robot-assisted resection at 7 high-volume centres. Perioperative outcomes, recurrences and overall survival were assessed. RESULTS: N2 disease was diagnosed preoperatively in 72 (32%) patients and intraoperatively in 151 (68%) patients. Surgical margins were negative in 98.4% of cases with available data. Thirty-four (15.2%) patients received neoadjuvant treatment, 140 (63%) patients received postoperative treatment, and 49 (22%) patients underwent surgery only. There were 22 (9.9%) conversions to thoracotomy, 23 (10.3%) had serious (Grades III-IV) postoperative morbidity and the mean hospital stay was 5.3 days. Complications and outcomes did not differ significantly between treatment groups. Of the 34 patients who were given neoadjuvant chemotherapy, all had R0 resection, 5 (15%) patients required conversion but none required conversion because of bleeding and 4 (12%) patients had Grade III or IV postoperative complications. After a median of 18 (interquartile range 8-33) months, 3-year overall survival in NSCLC patients was 61.2% and 60.3% (P = 0.6) of patients in the subgroup were given induction treatment. However, overall survival was significantly better (P = 0.012) in NSCLC patients with ≤2 positive nodes (vs >2). Nineteen (8.5%) patients developed local recurrence. CONCLUSIONS: Robot-assisted lobectomy is safe and effective in patients with Stage III NSCLC or carcinoid tumours with low conversions and complications. Among patients with NSCLC, including those who were given induction chemotherapy, survival was similar to that reported for open surgery.
OBJECTIVES: Minimally invasive surgery is accepted for early-stage lung cancer, but its role in locally advanced disease is controversial, especially using a robotic platform. The aim of this retrospective study was to assess the safety and effectiveness of robot-assisted resection in patients with Stage IIIA non-small-cell lung cancer (NSCLC) or carcinoid tumours in the series as a whole and in different subgroups according to adjuvant treatment. METHODS: This was a retrospective multicentre study of consecutive patients with clinically evident or occult N2 disease (210 NSCLC and 13 carcinoid) who, in 2007-2016, underwent robot-assisted resection at 7 high-volume centres. Perioperative outcomes, recurrences and overall survival were assessed. RESULTS: N2 disease was diagnosed preoperatively in 72 (32%) patients and intraoperatively in 151 (68%) patients. Surgical margins were negative in 98.4% of cases with available data. Thirty-four (15.2%) patients received neoadjuvant treatment, 140 (63%) patients received postoperative treatment, and 49 (22%) patients underwent surgery only. There were 22 (9.9%) conversions to thoracotomy, 23 (10.3%) had serious (Grades III-IV) postoperative morbidity and the mean hospital stay was 5.3 days. Complications and outcomes did not differ significantly between treatment groups. Of the 34 patients who were given neoadjuvant chemotherapy, all had R0 resection, 5 (15%) patients required conversion but none required conversion because of bleeding and 4 (12%) patients had Grade III or IV postoperative complications. After a median of 18 (interquartile range 8-33) months, 3-year overall survival in NSCLCpatients was 61.2% and 60.3% (P = 0.6) of patients in the subgroup were given induction treatment. However, overall survival was significantly better (P = 0.012) in NSCLCpatients with ≤2 positive nodes (vs >2). Nineteen (8.5%) patients developed local recurrence. CONCLUSIONS: Robot-assisted lobectomy is safe and effective in patients with Stage III NSCLC or carcinoid tumours with low conversions and complications. Among patients with NSCLC, including those who were given induction chemotherapy, survival was similar to that reported for open surgery.
Authors: Adwaiy Manerikar; Melissa Querrey; Emily Cerier; Samuel Kim; David D Odell; Lorenzo L Pesce; Ankit Bharat Journal: J Surg Res Date: 2020-12-09 Impact factor: 2.417