Peter J Kneuertz1, Danjouma H Cheufou2, Desmond M D'Souza3, Khaled Mardanzai2, Mahmoud Abdel-Rasoul4, Dirk Theegarten5, Susan D Moffatt-Bruce3, Clemens Aigner2, Robert E Merritt3. 1. Thoracic Surgery Division, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio. Electronic address: Peter.Kneuertz@osumc.edu. 2. Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany. 3. Thoracic Surgery Division, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio. 4. Center for Biostatistics, The Ohio State University, Columbus, Ohio. 5. University Hospital, University of Duisburg-Essen, Essen, Germany.
Abstract
OBJECTIVE: To assess the effectiveness of intraoperative lymph node (LN) staging by comparing upstaging between robotic-assisted surgery, video-assisted thoracoscopic surgery (VATS), and open thoracotomy approach for lobectomy for non-small cell lung cancer. METHODS: We retrospectively analyzed 1053 patients with clinical stage N0/N1 non-small cell lung cancer who underwent lobectomy at 2 centers between 2011 and 2018. Propensity score adjustment by inverse probability of treatment weighting was used to balance baseline characteristics. The primary end point was LN upstaging. RESULTS: A total of 911 patients (254 robotic, 296 VATS, and 261 open) were included in the inverse probability of treatment weighting adjusted analysis. The overall rate of LN upstaging was highest with open lobectomy (21.8%), followed by robotic (16.2%), and VATS (12.3%) (P = .03). Mediastinal N2 upstaging was observed in similar frequencies (open 6.9% vs robotic 6.3% vs VATS 4.4%; P = .6). No differences were seen for total LN counts, but were observed in the number of stations sampled (mean, open 4.0 vs robotic 3.8 vs VATS 3.6; P = .001). On multivariate analysis, LN upstaging was lower for VATS compared with open (odds ratio, 0.50; 95% confidence interval, 0.29-0.85), but not different between robotic and open (odds ratio, 0.72; 95% confidence interval, 0.44-1.18). No significant differences were seen in mediastinal N2 upstaging between groups. CONCLUSIONS: Pathologic LN upstaging following lobectomy for clinically N0/N1 NSCLC remains high. Compared with a traditional thoracotomy approach, robotic lobectomy was associated with similar and VATS with lower overall nodal upstaging. A thorough evaluation of hilar and mediastinal LNs remains critical to ensure accurate staging by detection of occult LN metastases.
OBJECTIVE: To assess the effectiveness of intraoperative lymph node (LN) staging by comparing upstaging between robotic-assisted surgery, video-assisted thoracoscopic surgery (VATS), and open thoracotomy approach for lobectomy for non-small cell lung cancer. METHODS: We retrospectively analyzed 1053 patients with clinical stage N0/N1 non-small cell lung cancer who underwent lobectomy at 2 centers between 2011 and 2018. Propensity score adjustment by inverse probability of treatment weighting was used to balance baseline characteristics. The primary end point was LN upstaging. RESULTS: A total of 911 patients (254 robotic, 296 VATS, and 261 open) were included in the inverse probability of treatment weighting adjusted analysis. The overall rate of LN upstaging was highest with open lobectomy (21.8%), followed by robotic (16.2%), and VATS (12.3%) (P = .03). Mediastinal N2 upstaging was observed in similar frequencies (open 6.9% vs robotic 6.3% vs VATS 4.4%; P = .6). No differences were seen for total LN counts, but were observed in the number of stations sampled (mean, open 4.0 vs robotic 3.8 vs VATS 3.6; P = .001). On multivariate analysis, LN upstaging was lower for VATS compared with open (odds ratio, 0.50; 95% confidence interval, 0.29-0.85), but not different between robotic and open (odds ratio, 0.72; 95% confidence interval, 0.44-1.18). No significant differences were seen in mediastinal N2 upstaging between groups. CONCLUSIONS: Pathologic LN upstaging following lobectomy for clinically N0/N1 NSCLC remains high. Compared with a traditional thoracotomy approach, robotic lobectomy was associated with similar and VATS with lower overall nodal upstaging. A thorough evaluation of hilar and mediastinal LNs remains critical to ensure accurate staging by detection of occult LN metastases.
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
Authors: Jia Huang; Yu Tian; Qian-Jun Zhou; Jun-Wei Ning; Ze-Nan Gu; Pei-Ji Lu; Jian-Tao Li; Hao Lin; Tian-Xiang Chen; Yun-Hai Yang; Min P Kim; Robert E Merritt; Marco Ghisalberti; Long Jiang; Qing-Quan Luo Journal: Transl Lung Cancer Res Date: 2021-12