Robotic thoracic surgery for non-small cell lung cancer: initial experience in Brazil

Abstract

Objective: To describe the morbidity, mortality, and rate of complete resection associated with robotic surgery for the treatment of non-small cell lung cancer in Brazil, as well as to report the rates of overall survival and disease-free survival in patients so treated. Methods: This was a retrospective study of patients diagnosed with non-small cell lung carcinoma and undergoing resection by robotic surgery at one of six hospitals in Brazil between February of 2015 and July of 2018. Data were collected retrospectively from the electronic medical records. Results: A total of 154 patients were included. The mean age was 65 ± 9.5 years (range, 30-85 years). The main histological diagnosis was adenocarcinoma, which was identified in 128 patients (81.5%), followed by epidermoid carcinoma, identified in 14 (9.0%). Lobectomy was performed in 133 patients (86.3%), and segmentectomy was performed in 21 (13.7%). The mean operative time was 209 ± 80 min. Postoperative complications occurred in 32 patients (20.4%). The main complication was air leak, which occurred in 15 patients (9.5%). The median (interquartile range) values for hospital stay and drainage time were 4 days (3-6 days) and 2 days (2-4 days), respectively. There was one death in the immediate postoperative period (30-day mortality rate, 0.5%). The mean follow-up period was 326 ± 274 days (range, 3-1,110 days). Complete resection was achieved in 97.4% of the cases. Overall mortality was 1.5% (3 deaths), and overall survival was 97.5%. Conclusions: Robotic pulmonary resection proved to be a safe treatment for lung cancer. Longer follow-up periods are required in order to assess long-term survival.

Directions for robotic surgery in the treatment of thoracic diseases in Brazil

“…Although the studies detailed above describe initial experiences in Brazil, (4,5) the morbidity and mortality rates reported are very similar to those reported in various international studies, (6) demonstrating that robotic surgery results in pleural drainage times and hospital stays are shorter than those reported for other techniques. (7) Oh et al (8) published results from a study of patients who underwent lobectomy in the USA.…”

“…This issue of the JBP includes the largest studies to date presenting the Brazilian experience with robotic surgery in the treatment of tumors of the thymus (4) and lung cancer. (5) Terra et al (4) report their initial experience in a sample of 18 patients with tumors of the thymus who underwent robotic surgery at a total of seven centers in Brazil. The authors reported technical aspects and results, such as operative time, extent of resection, length of hospital stay, and postoperative complications.…”

“…The most common application of robotic surgery in thoracic diseases is in the treatment of lung cancer, due to the high incidence of the disease. In another article published in this issue of the JBP, Terra et al (5) report the 40-month experience of six Brazilian institutions, with a collective total of 154 patients, using robotic surgery for the resection of lung cancer. The morbidity rate was 20.4%, and the mortality rate was 0.5%.…”

“…This issue of the JBP includes the largest studies to date presenting the Brazilian experience with robotic surgery in the treatment of tumors of the thymus 4 and lung cancer. 5 …”

Evolution of the surgical treatment of lung cancer at a tertiary referral center in Brazil, 2011-2018

“…(29) Outro fator que pode ter contribuído para a queda da mortalidade no período mais recente foi a melhora da técnica cirúrgica através do aumento na proporção de cirurgias minimamente invasivas, principalmente por videotoracoscopia, mas também pela via robótica, essa última iniciada em 2015. (30,31) A cirurgia mais realizada foi a lobectomia, correspondendo a mais de 80% dos casos nos dois períodos. Entretanto, observamos um aumento significativo da realização de segmentectomias no período mais recente, conforme tendência da literatura cirúrgica atual que reforça os benefícios de ressecções sublobares, surgindo como opção à lobectomia em pacientes com função pulmonar limitante, doença multifocal (32) ou doença inicial.…”