Robotic Surgery for Non-Small Cell Lung Cancer Treatment in High-Risk Patients

Abstract

Robotic-assisted pulmonary resection has greatly increased over the last few years, yet data on the application of robotic surgery in high-risk patients are still lacking. The objective of this study is to evaluate the perioperative outcomes in ASA III-IV patients who underwent robotic-assisted lung resection for NSCLC. Between January 2010 and December 2017, we retrospectively collected the data of 148 high-risk patients who underwent lung resection for NSCLC via a robotic approach at our institution. For this study, the prediction of operative risk was based on the ASA-PS score, considering patients in ASA III and IV classes as high-risk patients: of the 148 high-risk patients identified, 146 patients were classified as ASA III (44.8%) and two as ASA IV (0.2%). Possible prognostic factors were also analysed. The average hospital stay was 6 days (8–30). Post-operative complications were observed in 87 (58.8%) patients. Patients with moderate/severe COPD developed in 33 (80.5%) cases post-operative complications, while elderly patients in 25 (55%) cases, with a greater incidence of high-grade complications. No difference was observed when comparing the data of obese and non-obese patients. Robotic surgery appears to be associated with satisfying post-operative results in ASA III-IV patients. Both marginal respiratory function and advanced age represent negative prognostic factors. Due to its safety and efficacy, robotic surgery can be considered the treatment of choice in high-risk patients.

Comparison of Robotic and Open Lobectomy for Lung Cancer in Marginal Pulmonary Function Patients: A Single-Centre Retrospective Study

“…A longer hospital stay and a higher rate of postoperative complications were observed in COPD patients when compared with other high-risk patients. In addition, prolonged air leaks were recorded in 54.5% of patients in the COPD group, in contrast to 24.1% in the other high-risk patients [36].…”

Robotic versus Open Surgery in Locally Advanced Non-Small Cell Lung Cancer: Evaluation of Surgical and Oncological Outcomes

“…The patients were positioned in a lateral decubitus position with the operating table tilted at the tip of the scapula. A standardized port mapping was applied using a four-arm "totally endoscopic" approach [5]. CO 2 insufflation (5 mmHg) was applied to increase the thoracic space.…”

Comprehensive assessment of risk factors and pathogenic characteristics of wound infections following thoracoscopic radical resection for lung cancer

“…Its evolution has made it the preferred choice for lung cancer surgery, providing superior accuracy and patient outcomes. 7,8 Nevertheless, even with the progress made in surgical procedures and postoperative care, thoracoscopic radical resections still carry the risk of complications. 9 PWI represents a significant complication with specific concerns regarding its impact on patient recovery, healthcare costs and overall treatment outcomes.…”

“…This leads to less postoperative pain, shorter hospital stays and faster recovery. Its evolution has made it the preferred choice for lung cancer surgery, providing superior accuracy and patient outcomes 7,8 . Nevertheless, even with the progress made in surgical procedures and postoperative care, thoracoscopic radical resections still carry the risk of complications 9 …”