Joanna Sesti1, Russell C Langan2, Jaimie Bell3, Andrew Nguyen4, Amber L Turner2, Patrick Hilden5, Kalyna Leshchuk2, Michael Dabrowski2, Subroto Paul6. 1. Department of Thoracic Surgery, RWJBarnabas Health; Saint Barnabas Medical Center, West Orange, NJ; Department of Surgery, RWJBarnabas Health; Saint Barnabas Medical Center, Livingston, NJ. 2. Department of Surgery, RWJBarnabas Health; Saint Barnabas Medical Center, Livingston, NJ. 3. Department of Thoracic Surgery, RWJBarnabas Health; Saint Barnabas Medical Center, West Orange, NJ. 4. Department of Thoracic Surgery, RWJBarnabas Health; Monmouth Medical Center, West Long Branch, NJ. 5. Department of Biostatistics, RWJBarnabas Health; Saint Barnabas Medical Center, Livingston, NJ. 6. Department of Thoracic Surgery, RWJBarnabas Health; Saint Barnabas Medical Center, West Orange, NJ; Department of Surgery, RWJBarnabas Health; Saint Barnabas Medical Center, Livingston, NJ. Electronic address: subroto.paul@rwjbh.org.
Abstract
BACKGROUND: Minimally invasive lobectomy can be performed robotically or thoracoscopically. Short-term outcomes between the two approaches are reported to be similar; however, the comparative oncological effectiveness is not known. We sought to compare long-term survival after robotic and thoracoscopic lobectomy. METHODS: We performed a propensity matched analysis of SEER-Medicare patients with non-small cell lung cancer from 2008 to 2013 who underwent minimally invasive lobectomy using either a thoracoscopic (n=3881) or robotic assisted (n=426) approach. Patients in the two groups were propensity matched 1:1 based on demographics, comorbidities, treatment, and tumor characteristics. We compared the overall (OS) and cancer-specific mortality (CSM) between the two groups. RESULTS: Within the matched cohort (n=409 per group), the median (range) age at surgery was 73 (65-91) years, with a median follow-up of 35 months post surgery. There was no difference in OS or CSM between the thoracoscopic and robotic assisted groups (OS: 71.4% vs.73.1% at 3 years, overall p=0.366; CSM: 16.6% vs.14.9% at 3 years, overall p=0.639). CONCLUSIONS: Our propensity-matched analysis demonstrates that patients undergoing robotic-assisted lobectomy have similar overall survival and cancer-specific mortality compared to those patients undergoing thoracoscopic lobectomy. Oncologic outcomes are similar between the two minimally invasive approaches. These results demonstrate that further investigation is needed in the form of a randomized control trial, its variations, or additional large-scale registry analyses to verify these results.
BACKGROUND: Minimally invasive lobectomy can be performed robotically or thoracoscopically. Short-term outcomes between the two approaches are reported to be similar; however, the comparative oncological effectiveness is not known. We sought to compare long-term survival after robotic and thoracoscopic lobectomy. METHODS: We performed a propensity matched analysis of SEER-Medicare patients with non-small cell lung cancer from 2008 to 2013 who underwent minimally invasive lobectomy using either a thoracoscopic (n=3881) or robotic assisted (n=426) approach. Patients in the two groups were propensity matched 1:1 based on demographics, comorbidities, treatment, and tumor characteristics. We compared the overall (OS) and cancer-specific mortality (CSM) between the two groups. RESULTS: Within the matched cohort (n=409 per group), the median (range) age at surgery was 73 (65-91) years, with a median follow-up of 35 months post surgery. There was no difference in OS or CSM between the thoracoscopic and robotic assisted groups (OS: 71.4% vs.73.1% at 3 years, overall p=0.366; CSM: 16.6% vs.14.9% at 3 years, overall p=0.639). CONCLUSIONS: Our propensity-matched analysis demonstrates that patients undergoing robotic-assisted lobectomy have similar overall survival and cancer-specific mortality compared to those patients undergoing thoracoscopic lobectomy. Oncologic outcomes are similar between the two minimally invasive approaches. These results demonstrate that further investigation is needed in the form of a randomized control trial, its variations, or additional large-scale registry analyses to verify these results.
Authors: Jennie K Choe; Amy Zhu; Alexander J Byun; Junting Zheng; Kay See Tan; Joe Dycoco; Manjit S Bains; Matthew J Bott; Robert J Downey; James Huang; James M Isbell; Daniela Molena; Valerie W Rusch; Bernard J Park; Gaetano Rocco; Smita Sihag; David R Jones; Prasad S Adusumilli Journal: JTO Clin Res Rep Date: 2022-06-18