Long-term Survival Based on the Surgical Approach to Lobectomy For Clinical Stage I Nonsmall Cell Lung Cancer

Abstract

Objective To compare the long-term outcomes among robotic, video-assisted thoracic surgery (VATS), and open lobectomy in stage I non-small cell lung cancer (NSCLC). Summary Background Data Survival comparisons between robotic, VATS, and open lobectomy in NSCLC have not yet been reported. Some studies have suggested that survival following VATS is superior, for unclear reasons. Methods Three cohorts (robotic, VATS, and open) of clinical stage I NSCLC patients were matched by propensity score and compared to assess overall survival (OS) and disease-free survival (DFS). Univariate and multivariate analyses were performed to identify factors associated with the outcomes. Results From January 2002 to December 2012, 470 unique patients (172 robotic, 141 VATS, and 157 open) were included in the analysis. The robotic approach harvested a higher number of median stations of lymph nodes (5 for robotic vs 3 for VATS vs 4 for open; P<0.001). Patients undergoing minimally invasive approaches had shorter median length of hospital stay (4 days for robotic vs 4 days for VATS vs 5 days for open; P<0.001). The 5-year OS for the robotic, VATS, and open matched groups were 77.6%, 73.5%, and 77.9%, respectively without a statistically significant difference; corresponding 5-year DFS were 72.7%, 65.5%, and 69.0%, respectively, with a statistically significant difference between the robotic and VATS groups (P=0.047). However, multivariate analysis found that surgical approach was not independently associated with shorter OS and DFS. Conclusions Minimally invasive approaches to lobectomy for clinical stage I NSCLC result in similar long-term survival as thoracotomy. Use of VATS and robotics is associated with shorter length of stay, and the robotic approach resulted in greater lymph node assessment.

Robotic assisted lung resection needs further evidence

“…A recent publication of Yang HX et al (10) confirms the results of Park et al (11) regarding the estimation of survival after robotic lobectomy. Both studies confirm that Robotic lung resections result in similar long-term survival as compared with VATS and thoracotomy.…”

Robotic-assisted thoracoscopic segmentectomy: there is a long way to go

“…Other studies have shown no differences in the conversion rates from the R-VATS and VATS groups (5,8,9), albeit with higher conversion rates for the first 30 R-VATS.…”

Robotics in general thoracic surgery procedures

“…Most essential element for outcomes surveillance is making sure that the basic oncologic principles of lung cancer surgery are maintained consistent with Cancer and Leukemia Group B (CALGB) consensus and there is no compromise in disease eradication and pathologic staging parameters such as adequate surgical margin and lymph node harvest. As we will discuss later in this paper, robotic technology has been showed in several studies to provide same long term oncologic results as compared to open surgery (16). Additional outcome parameter such as analgesic pain requirements, early ambulation, postoperative complications such as pneumonia, DVT, hospital length of stay and cost considerations are also valuable quality control measures to keep track of.…”