Efficacy of Lymph Node Dissection During Robotic-assisted Lobectomy for Non-small Cell Lung Cancer: Retrospective Review of 159 Consecutive Cases

Overview

Journal J Thorac Dis

Publisher AME Publishing Company

Specialty Pulmonary Medicine

Date 2016 Oct 18

PMID 27746997

Citations 13

Authors

Frank O Velez-Cubian

Kathryn L Rodriguez

Matthew R Thau

Carla C Moodie

Joseph R Garrett

Jacques P Fontaine

Eric M Toloza

Affiliations

Soon will be listed here.

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.

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References

Little A, Rusch V, Bonner J, Gaspar L, Green M, Webb W . Patterns of surgical care of lung cancer patients. Ann Thorac Surg. 2005; 80(6):2051-6. DOI: 10.1016/j.athoracsur.2005.06.071. View

Paul S, Altorki N, Sheng S, Lee P, Harpole D, Onaitis M . Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg. 2010; 139(2):366-78. DOI: 10.1016/j.jtcvs.2009.08.026. View

Boffa D, Allen M, Grab J, Gaissert H, Harpole D, Wright C . Data from The Society of Thoracic Surgeons General Thoracic Surgery database: the surgical management of primary lung tumors. J Thorac Cardiovasc Surg. 2008; 135(2):247-54. DOI: 10.1016/j.jtcvs.2007.07.060. View

Verhagen A, Schoenmakers M, Barendregt W, Smit H, van Boven W, Looijen M . Completeness of lung cancer surgery: is mediastinal dissection common practice?. Eur J Cardiothorac Surg. 2012; 41(4):834-8. DOI: 10.1093/ejcts/ezr059. View

Goldstraw P, Crowley J, Chansky K, Giroux D, Groome P, Rami-Porta R . The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007; 2(8):706-14. DOI: 10.1097/JTO.0b013e31812f3c1a. View

Louie B . Robotic lobectomy - the future of minimally invasive lobectomy?. Chin J Cancer Res. 2013; 25(1):1-3. PMC: 3555292. DOI: 10.3978/j.issn.1000-9604.2012.09.04. View

Choi M, Park J, Kim H, Choi Y, Kim J, Shim Y . Analysis of 1,067 cases of video-assisted thoracic surgery lobectomy. Korean J Thorac Cardiovasc Surg. 2012; 44(2):169-77. PMC: 3249295. DOI: 10.5090/kjtcs.2011.44.2.169. View

Osarogiagbon R, Allen J, Farooq A, Wu J . Objective review of mediastinal lymph node examination in a lung cancer resection cohort. J Thorac Oncol. 2011; 7(2):390-6. DOI: 10.1097/JTO.0b013e31823e5e2d. View

Iyoda A, Makino T, Koezuka S, Otsuka H, Hata Y . Treatment options for patients with large cell neuroendocrine carcinoma of the lung. Gen Thorac Cardiovasc Surg. 2014; 62(6):351-6. PMC: 4042022. DOI: 10.1007/s11748-014-0379-9. View

10.

Cao C, Manganas C, Ang S, Yan T . A systematic review and meta-analysis on pulmonary resections by robotic video-assisted thoracic surgery. Ann Cardiothorac Surg. 2013; 1(1):3-10. PMC: 3741728. DOI: 10.3978/j.issn.2225-319X.2012.04.03. View

11.

Ceppa D, Kosinski A, Berry M, Tong B, Harpole D, Mitchell J . Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis. Ann Surg. 2012; 256(3):487-93. PMC: 4089858. DOI: 10.1097/SLA.0b013e318265819c. View

12.

Sugi K, Kaneda Y, Esato K . Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg. 1999; 24(1):27-30; discussion 30-1. DOI: 10.1007/s002689910006. View

13.

Watanabe A, Nakazawa J, Miyajima M, Harada R, Nakashima S, Mawatari T . Thoracoscopic mediastinal lymph node dissection for lung cancer. Semin Thorac Cardiovasc Surg. 2012; 24(1):68-73. DOI: 10.1053/j.semtcvs.2012.03.002. View

14.

Kent M, Wang T, Whyte R, Curran T, Flores R, Gangadharan S . Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg. 2013; 97(1):236-42. DOI: 10.1016/j.athoracsur.2013.07.117. View

15.

Boffa D, Kosinski A, Paul S, Mitchell J, Onaitis M . Lymph node evaluation by open or video-assisted approaches in 11,500 anatomic lung cancer resections. Ann Thorac Surg. 2012; 94(2):347-53. DOI: 10.1016/j.athoracsur.2012.04.059. View

16.

Park B . Robotic lobectomy for non-small cell lung cancer (NSCLC): Multi-center registry study of long-term oncologic results. Ann Cardiothorac Surg. 2013; 1(1):24-6. PMC: 3741713. DOI: 10.3978/j.issn.2225-319X.2012.04.09. View

17.

Watanabe A, Koyanagi T, Ohsawa H, Mawatari T, Nakashima S, Takahashi N . Systematic node dissection by VATS is not inferior to that through an open thoracotomy: a comparative clinicopathologic retrospective study. Surgery. 2005; 138(3):510-7. DOI: 10.1016/j.surg.2005.04.005. View

18.

Hagan M, Williams S, Socci L, Malik M, Internullo E, Martin-Ucar A . Completing the audit cycle improves surgical standards in lung cancer. Why do some patients still not receive the best care?. J Thorac Oncol. 2013; 8(6):779-82. DOI: 10.1097/JTO.0b013e31828c61a5. View

19.

Takagi H, Yamamoto H, Goto S, Matsui M, Umemoto T . Perioperative results of robotic lung lobectomy: summary of the literature. Surg Endosc. 2012; 26(12):3697-9. DOI: 10.1007/s00464-012-2292-6. View

20.

Yan T, Black D, Bannon P, McCaughan B . Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol. 2009; 27(15):2553-62. DOI: 10.1200/JCO.2008.18.2733. View