Nodal upstaging robotic lobectomy for non-small cell lung cancer

Abstract

Nodal upstaging takes place when unsuspected lymph node metastases are detected by pathological evaluation, after surgical treatment for non-small cell lung cancer. In early stages non-small cell lung cancer, nodal upstaging amounts to 4.8%-24.6%, depending on several factors, such as accuracy of preoperative staging, localisation and size of tumour and number of lymph nodes removed. Nodal upstaging is considered a surrogate of the completeness of thoracic oncologic surgery; for this reason, various studies focus on the evaluation of its rate in the different surgical approaches used to treat lung cancer. In this analysis, a high percentage of upstaging is observed in robotic surgery, having similar values to open surgery results, usually considered the gold standard in terms of oncologic radicality. In fact, thanks to its features, robotic surgery allows carrying out a thorough lymphadenectomy in the most comfortable manner, ensuring an excellent vision and manoeuvrability of the instruments even in the most remote areas of the thorax. According to these results, robotic surgery constitutes a safe and radical surgical option, showing encouraging results on the efficacy of lymphadenectomy and, consequently, on its the long-term outcomes.

Uniportal robotic‐assisted thoracoscopic surgery for early‐stage lung cancer with the Da Vinci Xi: Initial experience of two cases

“…Particularly, among all the variables evaluated, the nodal upstaging, defined as the presence of unsuspected pathologic metastasis in hilar or mediastinal lymph nodes detected at the final histologic analysis and considered a synonymous to the radicalness of oncologic resection, might be superior in RATS 26 …”

“…Indeed, thanks to its peculiar features, robotic surgery allows carrying out a thorough lymphadenectomy in the most comfortable manner, ensuring an excellent vision and maneuverability of the instruments even in the most remote areas of the thorax, leading to a more accurate staging and hence patient prognosis 9–11,17,26 …”

“…3,4,[7][8][9][10][11][12][13]17 Particularly, among all the variables evaluated, the nodal upstaging, defined as the presence of unsuspected pathologic metastasis in hilar or mediastinal lymph nodes detected at the final histologic analysis and considered a synonymous to the radicalness of oncologic resection, might be superior in RATS. 26 Indeed, thanks to its peculiar features, robotic surgery allows carrying out a thorough lymphadenectomy in the most comfortable manner, ensuring an excellent vision and maneuverability of the instruments even in the most remote areas of the thorax, leading to a more accurate staging and hence patient prognosis. [9][10][11]17,26 Though a technical advantage over U-VATS in performing a meticulous lymphadenectomy has been recognised during the herein reported initial practice of single port access robotic technique at our institution, the very limited evidences described so far in literature on the application of U-RATS do not allow a direct comparison between the two robotic approaches, uni-port and multi-port, for what concerns short-term and long-term outcomes or other parameters such as the number of harvested lymph nodes and the nodal upstaging.…”

“…26 Indeed, thanks to its peculiar features, robotic surgery allows carrying out a thorough lymphadenectomy in the most comfortable manner, ensuring an excellent vision and maneuverability of the instruments even in the most remote areas of the thorax, leading to a more accurate staging and hence patient prognosis. [9][10][11]17,26 Though a technical advantage over U-VATS in performing a meticulous lymphadenectomy has been recognised during the herein reported initial practice of single port access robotic technique at our institution, the very limited evidences described so far in literature on the application of U-RATS do not allow a direct comparison between the two robotic approaches, uni-port and multi-port, for what concerns short-term and long-term outcomes or other parameters such as the number of harvested lymph nodes and the nodal upstaging. On the other hand, utilisation of markedly expensive equipment and consequently major procedural costs of RATS represent the main controversies surrounding the methodic, 6,11,17 though recent data have suggested similar expenses of RATS compared to VATS and open thoracotomy at high volume centres.…”