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Cui Y, Grogan EL, Deppen SA, Wang F, Massion PP, Bailey CE, Zheng W, Cai H, Shu XO. Mortality for Robotic- vs Video-Assisted Lobectomy-Treated Stage I Non-Small Cell Lung Cancer Patients. JNCI Cancer Spectr 2020; 4:pkaa028. [PMID: 33215060 PMCID: PMC7660043 DOI: 10.1093/jncics/pkaa028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/03/2020] [Accepted: 04/07/2020] [Indexed: 12/24/2022] Open
Abstract
Background To address the US Food and Drug Administration’s recent safety concern on robotic surgery procedures, we compared short- and long-term mortality for stage I non-small cell lung cancer (NSCLC) patients treated by robotic-assisted thoracoscopic surgical lobectomy (RATS-L) vs video-assisted thoracoscopic surgical lobectomy (VATS-L). Methods From the National Cancer Database, we identified 18 908 stage I NSCLC patients who underwent RATS-L or VATS-L as the primary operation from 2010 to 2014. Cox proportional hazards models were used to estimate hazard ratios (HRs) for short- and long-term mortality using unmatched and propensity score–matched analyses. All statistical tests were 2-sided. Results Patients treated by RATS-L had higher 90-day mortality than those with VATS-L (6.6% vs 3.8%, P = .03) if conversion to open thoracotomy occurred. After excluding first-year observation, multiple regression analyses showed RATS-L was associated with increased long-term mortality, compared with VATS-L, in cases with tumor size 20 mm or less: hazard ratio (HR) = 1.33 (95% confidence interval [CI] = 1.15 to 1.55), HR = 1.36 (95% CI = 1.17 to 1.58), and HR = 1.33 (95% CI = 1.11 to 1.61) for unmatched, N:1 matched, and 1:1 matched analyses, respectively, in the intention-to-treat analysis. Among patients without conversion to an open thoracotomy, the respective hazard ratios were 1.19 (95% CI = 1.10 to 1.29), 1.19 (95% CI = 1.10 to 1.29), and 1.17 (95% CI = 1.06 to 1.29). Similar associations were observed when follow-up time started 18 or 24 months postsurgery. No statistically significant mortality difference was found for patients with tumor size of greater than 20 mm. These associations were not related to case volume of VATS-L or RATS-L performed at treatment institutes. Conclusions Patients with small (≤20 mm) stage I NSCLC treated with RATS-L had statistically significantly higher long-term mortality risk than VATS-L after 1 year postsurgery.
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Affiliation(s)
- Yong Cui
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Eric L Grogan
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen A Deppen
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fei Wang
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Pierre P Massion
- Division of Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Christina E Bailey
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Hui Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
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Abstract
Minimally invasive surgery for diseases of the chest offsets the morbidity of painful thoracic incisions while allowing for meticulous dissection of major anatomic structures. This benefit translates to improved outcomes and recovery following the surgical management of benign and malignant esophageal pathologic condition, mediastinal tumors, and lung resections. This anatomic region is particularly amenable to a robotic approach given the fixed space and need for complex intracorporeal dissection. As robotic platforms continue to evolve, more complex thoracic surgical interventions will be facilitated, translating to improved outcomes for our patients.
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Affiliation(s)
- Gary Schwartz
- Department of Thoracic Surgery & Lung Transplantation, Baylor University Medical Center, Texas A&M Health Science Center, 3410 Worth Street, Suite 545, Dallas, TX 75246, USA.
| | - Manu Sancheti
- Emory Saint Joseph's Hospital, Emory Healthcare, 5665 Peachtree Dunwoody Road #200, Atlanta, GA 30342, USA
| | - Justin Blasberg
- Yale School of Medicine, Lauder Hall, 310 Cedar Street, New Haven, CT 06510, USA
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Suda K. For a better adjuvant strategy for resected lung cancer-lessons from treatment failure patterns of the ADJUVANT trial (CTONG 1104). Transl Lung Cancer Res 2019; 8:S395-S399. [PMID: 32038923 PMCID: PMC6987354 DOI: 10.21037/tlcr.2019.08.24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 08/27/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Kenichi Suda
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
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Kneuertz PJ, D'Souza DM, Richardson M, Abdel-Rasoul M, Moffatt-Bruce SD, Merritt RE. Long-Term Oncologic Outcomes After Robotic Lobectomy for Early-stage Non-Small-cell Lung Cancer Versus Video-assisted Thoracoscopic and Open Thoracotomy Approach. Clin Lung Cancer 2019; 21:214-224.e2. [PMID: 31685354 DOI: 10.1016/j.cllc.2019.10.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/09/2019] [Accepted: 10/01/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although robotic-assisted lobectomy has been increasingly used for resection of non-small-cell lung cancer (NSCLC), the long-term oncologic outcomes compared with video-assisted thoracoscopic surgery (VATS) and the open thoracotomy approach have remained ill-defined. PATIENTS AND METHODS Society of Thoracic Surgeons outcomes data and surveillance records of patients with stage I-IIIa NSCLC who had undergone lobectomy by robotic-assisted, VATS, or the open approach at a single center from 2012 to 2017 were reviewed. Propensity score adjustment by inverse probability of treatment weighting was used to balance the baseline characteristics. Recurrence and survival were analyzed and compared by the operative approach. RESULTS The inverse probability of treatment weighting-adjusted cohort included 514 patients with NSCLC who had undergone robotic-assisted (n = 245), VATS (n = 118), and open (n = 151) lobectomy, with similar patient and disease characteristics. The minimally invasive procedures were associated with a shorter median hospital length of stay (robotic, 5.2 days; VATS, 4.9 days; open, 7.3 days; P < .001) and 0-adjusted 30-day mortality rate. With a median follow-up period of 45 months, the incidence for locoregional recurrence (robotic, 7%; VATS, 6%; open, 8%; P = .9) and distant failure (robotic, 14%; VATS, 18%; open, 17%; P = .9) was similar. The 5-year overall survival for robotic-assisted, VATS, and open lobectomy was 63%, 55%, and 65%, respectively (P = .56). No difference was found in stage-specific survival for stage I, II, and IIIa. On multivariate analysis, the robotic approach was associated with no differences in overall survival and recurrence-free survival compared with VATS and open lobectomy. CONCLUSION Robotic lobectomy was associated with durable freedom of recurrence and long-term survival equivalent to those achieved with VATS and the traditional open thoracotomy approach.
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Affiliation(s)
- Peter J Kneuertz
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Desmond M D'Souza
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Morgan Richardson
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mahmoud Abdel-Rasoul
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
| | - Susan D Moffatt-Bruce
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Robert E Merritt
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
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Demmy TL, Yendamuri S. Oncologic validity of minimally invasive lobectomy for early stage lung cancer. J Thorac Dis 2019; 11:E163-E167. [PMID: 31737329 DOI: 10.21037/jtd.2019.09.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
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