Efficacy of lymph node dissection during robotic-assisted lobectomy for non-small cell lung cancer: retrospective review of 159 consecutive cases

Abstract

Background:We investigated whether robotic-assisted surgery improves mediastinal lymph node dissection (MLND). Methods: We analyzed patients (pts) who underwent robotic-assisted video-assisted thoracoscopic surgery (R-VATS) lobectomy for non-small cell lung cancer (NSCLC) over 36 months. Perioperative outcomes, tumor histology, numbers, locations, and status of all lymph nodes (LNs), and TNM (tumor, nodal, and metastasis) stage changes were analyzed. Results: One hundred fifty-nine pts had mean tumor size 3.3±0.2 cm, most commonly being adenocarcinoma. Assessment of ≥3 N2 stations occurred in 156 (98.1%) pts, with 141 (88.7%) pts having >3 N2 stations reported. Mean total N1 + N2 stations assessed was 5.6±0.1 stations, including mean 4.1±0.1 N2 stations assessed. Mean N2 LNs reported was 7.2±0.3 LNs, and mean total N1 + N2 LNs reported was 13.4±0.4 LNs. There were 118 (74.2%) clinical stage-I pts versus 96 (60.4%) pathologic stage-I pts. Overall, 48 (30.2%) pts were upstaged, including 13 pts with cN0-pN1, 13 pts with cN0-pN2, 4 pts with cN1-pN2, and 18 pts with changes in T. Conclusions: R-VATS lobectomy is safe and results in perioperative outcomes comparable to those reported for conventional VATS. R-VATS MLND is effective at detecting occult metastatic disease during lobectomy for NSCLC.

Impact of da Vinci Xi robot in pulmonary resection

“…Other studies have shown no differences in the numbers of LNs removed by robot-assisted procedures compared to VATS (22,24,26). However, our results showed a greater number of LNs harvested by robotic approaches in comparison to VATS approaches; this finding is consistent with prior publications that showed the superiority of robotic approaches in the number of retrieved LNs (27). Our ability to harvest lymph nodes also improved over time with the highest number of lymph node being harvested during the mature robot period.…”

Propensity-score adjusted comparison of pathologic nodal upstaging by robotic, video-assisted thoracoscopic, and open lobectomy for non–small cell lung cancer

“…Most recently, the use of robotic lung surgery is increasing rapidly, and several studies have reported good experiences with LN dissection, and nodal upstaging ranging from 10% to 16.4%. [12][13][14]16,17 The relative ease of LN dissection is credited to the high-definition robotic camera and the wristed robotic instrumentation with increased freedom of motion and maneuverability in the chest. 18 In a multi-institutional effort, Wilson and colleagues 14 reported a rate of nodal upstaging of 10.9% for clinical stage I NSCLC that they compare favorably to historic VATS data.…”

Effect of Obesity on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy

“…First, our mean number of mediastinal (N2) LN stations reported was 3.7 ± 0.1 LN stations, with a total number of individual hilar and mediastinal (N1+N2) LNs being 13.4 ± 0.4 LNs. 36 These numbers with regard to our study groups are shown in Table 8. Mediastinal LN dissection has been one of the areas benefited by the robotic-assisted approach compared with conventional modalities.…”