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Multicenter Study
. 2018 Nov 1;54(5):912-919.
doi: 10.1093/ejcts/ezy166.

Robotic resection of Stage III lung cancer: an international retrospective study

Giulia Veronesi  1 , Bernard Park  2 , Robert Cerfolio  3 , Mark Dylewski  4 , Alpert Toker  5 , Jacques P Fontaine  6   7   8 , Wael C Hanna  9   10 , Emanuela Morenghi  11   12 , Pierluigi Novellis  1 , Frank O Velez-Cubian  7 , Marisa H Amaral  6 , Elisa Dieci  1 , Marco Alloisio  1   12 , Eric M Toloza  6   7   8
Affiliations
Multicenter Study

Robotic resection of Stage III lung cancer: an international retrospective study

Giulia Veronesi et al. Eur J Cardiothorac Surg. .

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.

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Figures

Figure 1:
Figure 1:
The Kaplan–Meier overall survival (OS) curves for non-small-cell lung cancer (NSCLC) patients. (A) OS for the entire NSCLC cohort. (B) OS according to whether patients received preoperative chemotherapy (which could also be associated with postoperative treatment), postoperative treatment only or no or unknown adjuvant treatment.
Figure 2:
Figure 2:
The Kaplan–Meier overall survival (OS) curves for non-small-cell lung cancer (NSCLC) patients according to lymph node involvement. (A) OS according to the presence of clinically evident or occult lymph node metastasis. (B) OS according to the number of positive lymph nodes (≤2 and >2). (C) OS according to the presence or absence of skip metastases.
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