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Forcada C, Gómez-Hernández MT, Rivas C, Fuentes M, Novoa N, Varela G, Jiménez M. Operative outcomes and middle-term survival of robotic-assisted lung resection for clinical stage IA lung cancer compared with video-assisted thoracoscopic surgery. Cir Esp 2024; 102:90-98. [PMID: 37967649 DOI: 10.1016/j.cireng.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Despite limited published evidence, robotic-assisted thoracoscopic surgery (RATS) for anatomic lung resection in early-stage lung cancer continues growing. The aim of this study is to evaluate its safety and oncologic efficacy compared to video-assisted thoracoscopic surgery (VATS). METHODS Single-centre retrospective study of all patients with resected clinical stage IA NSCLC who underwent RATS or VATS anatomic lung resection from June 2018 to January 2022. RATS and VATS cases were matched by propensity scoring (PSM) according to age, sex, histology, and type of resection. Short-term outcomes were compared, and the Kaplan-Meier method and log-rank test were used to evaluate the overall survival (OS) and disease-free survival (DFS). RESULTS 321 patients (94 RATS and 227 VATS cases) were included. After PSM, 94 VATS and 94 RATS cases were compared. Demographics, pulmonary function, and comorbidity were similar in both groups. Overall postoperative morbidity was comparable for RATS and VATS cases (20.2% vs 25.5%, P = 0.385, respectively). Pathological nodal upstaging was similar in both groups (10.6% in RATS and 12.8% in VATS). During the 3.5-year follow-up period (median: 29 months; IQR: 18-39), recurrence rate was 6.4% in RATS group and 18.1% in the VATS group (P = 0.014). OS and DFS were similar in RATS and VATS groups (log rank P = 0.848 and P = 0.117, respectively). CONCLUSION RATS can be performed safely in patients with early-stage NSCLC. For clinical stage IA disease, robotic anatomic lung resection offers better oncologic outcomes in terms of recurrence, although there are no differences in OS and DFS compared with VATS.
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Affiliation(s)
- Clara Forcada
- Service of Thoracic Surgery, Salamanca University Hospital. Salamanca, Spain
| | | | - Cristina Rivas
- Service of Thoracic Surgery, Salamanca University Hospital. Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
| | - Marta Fuentes
- Service of Thoracic Surgery, Salamanca University Hospital. Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
| | - Nuria Novoa
- Service of Thoracic Surgery, Salamanca University Hospital. Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
| | - Gonzalo Varela
- Salamanca Institute of Biomedical Research, Salamanca, Spain
| | - Marcelo Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital. Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
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Rogers MP, Janjua H, Read M, Pietrobon R, Kuo PC. Interpretable machine learning accurately reclassifies lobectomy surgical approaches by cost. Surgery 2023; 174:1422-1427. [PMID: 37833152 DOI: 10.1016/j.surg.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND The volume of robotic lung resection continues to increase despite its higher costs and unproven superiority to video-assisted thoracoscopic surgery. We evaluated whether machine learning can accurately identify factors influencing cost and reclassify high-cost operative approaches into lower-cost alternatives. METHODS The Florida Agency for Healthcare Administration and Centers for Medicare and Medicaid Services Hospital and Physician Compare datasets were queried for patients undergoing open, video-assisted thoracoscopic surgery and robotic lobectomy. K-means cluster analysis was used to identify robotic clusters based on total cost. Predictive models were built using artificial neural networks, Support Vector Machines, Classification and Regression Trees, and Gradient Boosted Machines algorithms. Models were applied to the high-volume robotic group to determine patients whose cost cluster changed if undergoing a video-assisted thoracoscopic surgery approach. A local interpretable model-agnostic explanation approach personalized cost per patient. RESULTS Of the 6,618 cases included in the analysis, we identified 4 cost clusters. Application of artificial neural networks to the robotic subgroup identified 1,642 (65%) cases with no re-assignment of cost cluster, 583 (23%) with reduced costs, and 300 (12%) with increased costs if they had undergone video-assisted thoracoscopic surgery approach. The 5 overall highest cost predictors were patient admission from the clinic, diagnosis of metastatic cancer, presence of cancer, urgent hospital admission, and dementia. CONCLUSION K-means cluster analysis and machine learning identify a patient population that may undergo video-assisted thoracoscopic surgery or robotic lobectomy without a significant difference in total cost. Local interpretable model-agnostic explanation identifies individual patient factors contributing to cost. Application of this modeling may reliably stratify high-cost patients into lower-cost approaches and provide a rationale for reducing expenditure.
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Affiliation(s)
- Michael P Rogers
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Haroon Janjua
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Meagan Read
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | | | - Paul C Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL.
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Fabbri G, Femia F, Lampridis S, Farinelli E, Maraschi A, Routledge T, Bille A. Long-Term Oncologic Outcomes in Robot-Assisted and Video-Assisted Lobectomies for Non-Small Cell Lung Cancer. J Clin Med 2023; 12:6609. [PMID: 37892747 PMCID: PMC10607558 DOI: 10.3390/jcm12206609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
This study compares long-term outcomes in patients undergoing video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) lobectomy for non-small cell lung cancer (NSCLC); all consecutive patients who underwent RATS or VATS lobectomy for NSCLC between July 2015 and December 2021 in our center were enrolled in a single-center prospective study. The primary outcomes were overall survival (OS), disease-free survival (DFS), and recurrence rate. The secondary outcomes were complication rate, length of hospitalization (LOS), duration of chest tubes (LOD), and number of lymph node stations harvested. A total of 619 patients treated with RATS (n = 403) or VATS (n = 216) were included in the study. There was no significant difference in OS between the RATS and VATS groups (3-year OS: 75.9% vs. 82.3%; 5-year OS: 70.5% vs. 68.5%; p = 0.637). There was a statistically significant difference in DFS between the RATS and VATS groups (3-year DFS: 92.4% vs. 81.2%; 5-year DFS: 90.3% vs. 77.6%; p < 0.001). Subgroup analysis according to the pathological stage also demonstrated a significant difference between RATS and VATS groups in DFS in stage I (3-year DFS: 94.4% vs. 88.9%; 5-year DFS: 91.8% vs. 85.2%; p = 0.037) and stage III disease (3-year DFS: 82.4% vs. 51.1%; 5-year DFS: 82.4% vs. 37.7%; p = 0.024). Moreover, in multivariable Cox regression analysis, the surgical approach was significantly associated with DFS, with an HR of 0.46 (95% CI 0.27-0.78, p = 0.004) for RATS compared to VATS. VATS lobectomy was associated with a significantly higher recurrence rate compared to RATS (21.8% vs. 6.2%; p < 0.001). LOS and LOD, as well as complication rate and in-hospital and 30-day mortality, were similar among the groups. RATS lobectomy was associated with a higher number of lymph node stations harvested compared to VATS (7 [IQR:2] vs. 5 [IQR:2]; p < 0.001). In conclusion, in our series, RATS lobectomy for lung cancer led to a significantly higher DFS and significantly lower recurrence rate compared to the VATS approach. RATS may allow more extensive nodal dissection, and this could translate into reduced recurrence.
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Affiliation(s)
- Giulia Fabbri
- Department of Thoracic Surgery, Guy’s and St. Thomas’ NHS Trust Foundation, London SE1 9RT, UK; (F.F.); (S.L.); (E.F.); (A.M.); (T.R.); (A.B.)
- AOU Città della Salute e della Scienza di Torino, University of Turin, 10124 Turin, Italy
| | - Federico Femia
- Department of Thoracic Surgery, Guy’s and St. Thomas’ NHS Trust Foundation, London SE1 9RT, UK; (F.F.); (S.L.); (E.F.); (A.M.); (T.R.); (A.B.)
- AOU Città della Salute e della Scienza di Torino, University of Turin, 10124 Turin, Italy
| | - Savvas Lampridis
- Department of Thoracic Surgery, Guy’s and St. Thomas’ NHS Trust Foundation, London SE1 9RT, UK; (F.F.); (S.L.); (E.F.); (A.M.); (T.R.); (A.B.)
| | - Eleonora Farinelli
- Department of Thoracic Surgery, Guy’s and St. Thomas’ NHS Trust Foundation, London SE1 9RT, UK; (F.F.); (S.L.); (E.F.); (A.M.); (T.R.); (A.B.)
- St. Orsola-Malpighi University Hospital, University of Bologna, 40126 Bologna, Italy
| | - Alessandro Maraschi
- Department of Thoracic Surgery, Guy’s and St. Thomas’ NHS Trust Foundation, London SE1 9RT, UK; (F.F.); (S.L.); (E.F.); (A.M.); (T.R.); (A.B.)
| | - Tom Routledge
- Department of Thoracic Surgery, Guy’s and St. Thomas’ NHS Trust Foundation, London SE1 9RT, UK; (F.F.); (S.L.); (E.F.); (A.M.); (T.R.); (A.B.)
| | - Andrea Bille
- Department of Thoracic Surgery, Guy’s and St. Thomas’ NHS Trust Foundation, London SE1 9RT, UK; (F.F.); (S.L.); (E.F.); (A.M.); (T.R.); (A.B.)
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4
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Huang R, Xiao Y, Jiang F, Chen Y, Su C, Zhou J, Yang T. Elevated respiratory complications following robotic-assisted lobectomy: A national cohort analysis of 26,140 cases. Int J Med Robot 2023:e2581. [PMID: 37743652 DOI: 10.1002/rcs.2581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/23/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Robotic-assisted lobectomy (RL) is increasingly used nationally, but little comparative data exist on its safety compared with open lobectomy (OL) or video-assisted lobectomy (VL). This study aimed to estimate the risk of perioperative complications for RL, VL, or OL. METHODS Admissions were identified from the hospital administrative data collected between 2015 and 2019. Propensity score matching and inverse probabilistic weighting were used to account for selection bias. Logistic and quantile regression models were applied to determine perioperative outcome differences. RESULTS We identified 26,140 cases of which 5337 (20.4%), 12,680 (48.5%), and 8123 (31.1%) underwent RL, VL, and OL. RL and VL were associated with lower complication rates, shorter lengths of stay, and fewer mortality risks. RL was associated with significantly elevated risks for perioperative respiratory complications (adjusted odds ratio 1.10, p = 0.010). CONCLUSION Relatively low rates of perioperative complications for VL and RL, and higher respiratory complication rates in RL are concerning.
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Affiliation(s)
- Ruijian Huang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Yue Xiao
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Feng Jiang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Yanfei Chen
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Cunhua Su
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jifang Zhou
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Tianchi Yang
- Immunization Centre, Ningbo Municipal Centre for Disease Control and Prevention, Ningbo, Zhejiang, China
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Bedetti B, Zalepugas D, Arensmeyer JC, Feodorovici P, Schmidt J. [Robotics in thoracic surgery]. Pneumologie 2023; 77:374-385. [PMID: 37311471 DOI: 10.1055/a-1854-2770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The increasing diffusion of the robotic-assisted technique in thoracic surgery (RATS) in Germany was initially delayed in comparison with other countries. Therefore, there is a large potential to implement the volume of the surgical procedures performed by RATS.The RATS-technique has many positive aspects. For example, the angulated instruments allow a full wristed dexterity like the human hand, but with a greater range of motion. The surgical Robot has a tremor filter and replicates perfectly the surgeon's movements. Furthermore, the 3D-scope enables an image magnification up to 10 times compared to the normal thoracoscopes. The RATS has also some disadvantages. For example, the operating surgeon sits far away from the patient and is not sterile while performing surgery. This is an important factor in in case of emergency situations, like major bleeding, which often require a conversion to thoracotomy.All robotic systems are built after the same master-slave technology, that allows the operating surgeon to have full control of the master system. The slave system consists of mechanical actuators that respond to the master system's inputs, so the surgical robot will translate every single movement of the surgeon at the console.The main surgical indications for RATS are: mediastinal tumors, diaphragm plication and anatomical lung resection like segment resections, lobectomies or sleeve resections.In the future, the implementation of virtual and augmented reality is expected in the training but also in the planning of RATS-operations.
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Kent MS, Hartwig MG, Vallières E, Abbas AE, Cerfolio RJ, Dylewski MR, Fabian T, Herrera LJ, Jett KG, Lazzaro RS, Meyers B, Reddy RM, Reed MF, Rice DC, Ross P, Sarkaria IS, Schumacher LY, Spier LN, Tisol WB, Wigle DA, Zervos M. Pulmonary Open, Robotic, and Thoracoscopic Lobectomy (PORTaL) Study: Survival Analysis of 6646 Cases. Ann Surg 2023; 277:1002-1009. [PMID: 36762564 DOI: 10.1097/sla.0000000000005820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE The aim of this study was to analyze overall survival (OS) of robotic-assisted lobectomy (RL), video-assisted thoracoscopic lobectomy (VATS), and open lobectomy (OL) performed by experienced thoracic surgeons across multiple institutions. SUMMARY BACKGROUND DATA Surgeons have increasingly adopted RL for resection of early-stage lung cancer. Comparative survival data following these approaches is largely from single-institution case series or administrative data sets. METHODS Retrospective data was collected from 21 institutions from 2013 to 2019. Consecutive cases performed for clinical stage IA-IIIA lung cancer were included. Induction therapy patients were excluded. The propensity-score method of inverse-probability of treatment weighting was used to balance baseline characteristics. OS was estimated using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to evaluate association among OS and relevant risk factors. RESULTS A total of 2789 RL, 2661 VATS, and 1196 OL cases were included. The unadjusted 5-year OS rate was highest for OL (84%) followed by RL (81%) and VATS (74%); P =0.008. Similar trends were also observed after inverse-probability of treatment weighting adjustment (RL 81%; VATS 73%, OL 85%, P =0.001). Multivariable Cox regression analyses revealed that OL and RL were associated with significantly higher OS compared with VATS (OL vs. VATS: hazard ratio=0.64, P <0.001 and RL vs. VATS: hazard ratio=0.79; P =0.007). CONCLUSIONS Our finding from this large multicenter study suggests that patients undergoing RL and OL have statistically similar OS, while the VATS group was associated with shorter OS. Further studies with longer follow-up are necessary to help evaluate these observations.
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Affiliation(s)
- Michael S Kent
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Eric Vallières
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA
| | - Abbas E Abbas
- Division of Thoracic Surgery, Temple University Health System, Philadelphia, PA
| | | | - Mark R Dylewski
- General Thoracic Surgery, Baptist Health Medical Group, South Miami, FL
| | - Thomas Fabian
- Division of Thoracic Surgery, Albany Medical Center, Albany, NY
| | - Luis J Herrera
- Rod Taylor Thoracic Care Center, Orlando Health UF Health Cancer Center, Orlando FL
| | - Kimble G Jett
- Division of Thoracic Surgery, Baylor Scott & White The Heart Hospital-Plano, Plano, TX
| | - Richard S Lazzaro
- Department of Cardiothoracic Surgery, Northwell Health, New York, NY
| | - Bryan Meyers
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Rishindra M Reddy
- Division of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, MI
| | - Michael F Reed
- Division of Thoracic Surgery, Penn State Cancer Institute, Hershey, PA
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer, Houston, TX
| | - Patrick Ross
- Main Line Health Care Thoracic Surgery, Main Line Health, Wynewood, PA
| | - Inderpal S Sarkaria
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Lana Y Schumacher
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA
| | - Lawrence N Spier
- Department of Cardiothoracic Surgery, Northwell Health, New York, NY
| | - William B Tisol
- Division of Thoracic Surgery, Aurora Health Care, Grafton, MI
| | - Dennis A Wigle
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN
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Lampridis S, Maraschi A, Le Reun C, Routledge T, Billè A. Robotic versus Video-Assisted Thoracic Surgery for Lung Cancer: Short-Term Outcomes of a Propensity Matched Analysis. Cancers (Basel) 2023; 15:cancers15082391. [PMID: 37190319 DOI: 10.3390/cancers15082391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Robot-assisted thoracic surgery (RATS) has gained popularity for the treatment of lung cancer, but its quality outcome measures are still being evaluated. The purpose of this study was to compare the perioperative outcomes of lung cancer resection using RATS versus video-assisted thoracic surgery (VATS). To achieve this aim, we conducted a retrospective analysis of consecutive patients who underwent lung cancer surgery between July 2015 and December 2020. A propensity-matched analysis was performed based on patients' performance status, forced expiratory volume in 1 s% of predicted, diffusing capacity of the lungs for carbon monoxide% of predicted, and surgical procedure (lobectomy or segmentectomy). Following propensity matching, a total of 613 patients were included in the analysis, of which 328 underwent RATS, and 285 underwent VATS, with satisfactory performance indicators. The results of the analysis indicated that RATS had a significantly longer operating time than VATS (132.4 ± 37.3 versus 122.4 ± 27.7 min; mean difference of 10 min 95% CI [confidence interval], 4.2 to 15.9 min; p = 0.001). On the other hand, VATS had a significantly higher estimated blood loss compared to RATS (169.7 ± 237.2 versus 82.2 ± 195.4 mL; mean difference of 87.5 mL; 95% CI, 48.1 to 126.8 mL; p < 0.001). However, there were no significant differences between the groups in terms of the duration of chest tubes, length of hospital stay, low- and high-grade complications, as well as readmissions and mortality within 30 days after surgery. Moreover, the number of dissected lymph-node stations was significantly higher with VATS than RATS (5.9 ± 1.5 versus 4.8 ± 2.2; mean difference of 1.2; 95% CI, 0.8 to 1.5; p = 0.001). Nonetheless, the percentage of patients who were upstaged after histopathological analysis of the resected lymph nodes was similar between the two groups. In conclusion, RATS and VATS yielded comparable results for most of the short-term outcomes assessed. Further research is needed to validate the implementation of RATS and identify its potential benefits over VATS.
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Affiliation(s)
- Savvas Lampridis
- Department of Thoracic Surgery, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Alessandro Maraschi
- Department of Thoracic Surgery, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Corinne Le Reun
- Independent Biostatistician, 97180 Sainte-Anne, Guadeloupe, France
| | - Tom Routledge
- Department of Thoracic Surgery, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Andrea Billè
- Department of Thoracic Surgery, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
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8
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Robotic Lobectomy. Thorac Surg Clin 2023; 33:33-41. [DOI: 10.1016/j.thorsurg.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Alwatari Y, Khoraki J, Wolfe LG, Ramamoorthy B, Wall N, Liu C, Julliard W, Puig CA, Shah RD. Trends of utilization and perioperative outcomes of robotic and video-assisted thoracoscopic surgery in patients with lung cancer undergoing minimally invasive resection in the United States. JTCVS OPEN 2022; 12:385-398. [PMID: 36590738 PMCID: PMC9801282 DOI: 10.1016/j.xjon.2022.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/04/2022] [Accepted: 07/05/2022] [Indexed: 04/27/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate utilization and perioperative outcomes of video-assisted thoracoscopic surgery (VATS) or robotic-assisted thoracoscopic surgery (RATS) for lung cancer in the United States using a nationally representative database. METHODS Hospital admissions for lobectomy or sublobar resection (segmentectomy or wedge resection) using VATS or RATS in patients with nonmetastatic lung cancer from October 2015 through December 2018 in the National Inpatient Sample were studied. Patient and hospital characteristics, perioperative complications and mortality, length of stay (LOS), and total hospital cost were compared. Logistic regression was used to assess whether the surgical approach was independently associated with adverse outcomes. RESULTS There were 83,105 patients who had VATS (n = 65,375) or RATS (n = 17,710) for lobectomy (72.7% VATS) or sublobar resection (84.2% VATS). Utilization of RATS for lobectomy and sublobar resection increased from 19.2% to 34% and 7.3% to 22%, respectively. Mortality, LOS, and conversion rates were comparable. The cost was higher for RATS (P <.01). Multivariate analyses showed comparable RATS and VATS complications with no independent association between the minimally invasive surgery approach used and adverse surgical outcomes, except for a decreased risk of pneumonia with RATS, relative to VATS sublobar resection (P <.01). Thoracic complication rates and LOS decreased after RATS lobectomy in 2018, compared with previous years (P <.005). CONCLUSIONS The utilization of robotic-assisted lung resection for cancer has increased in the United States between 2015 and 2018 for sublobar resection and lobectomy. In adjusted regression analysis, compared with VATS, patients who underwent RATS had similar complication rates and LOS. The robotic approach was associated with increased total hospital cost. LOS and thoracic complication rates trended down after RATS lobectomy.
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Key Words
- HCUP, Healthcare Cost and Utilization Project
- ICD-10, International Classification of Diseases, 10th Revision
- ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification
- ICD-10-PCS, International Classification of Diseases, 10th Revision Procedure Coding System
- LOS, length of stay
- MIS, minimally invasive surgery
- NIS, National Inpatient Sample
- Q4, fourth quarter
- RATS, robotic-assisted thoracoscopic surgery
- VATS, video-assisted thoracoscopic surgery
- lung cancer
- robotic
- video-assisted thoracoscopic surgery
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Affiliation(s)
- Yahya Alwatari
- Address for reprints: Yahya Alwatari, MD, 1200 E Marshall St, Richmond, VA 23298.
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Choe JK, Zhu A, Byun AJ, Zheng J, Tan KS, Dycoco J, Bains MS, Bott MJ, Downey RJ, Huang J, Isbell JM, Molena D, Rusch VW, Park BJ, Rocco G, Sihag S, Jones DR, Adusumilli PS. Brief Report: Contralateral Lobectomy for Second Primary NSCLC: Perioperative and Long-Term Outcomes. JTO Clin Res Rep 2022; 3:100362. [PMID: 35859764 PMCID: PMC9289639 DOI: 10.1016/j.jtocrr.2022.100362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/25/2022] [Accepted: 06/10/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Anatomical resection-often by lobectomy-is the standard of care for patients with early stage NSCLC. With increased diagnosis, survival, and prevalence of persons with early stage NSCLC, the incidence of second primary NSCLC, and consequently, the need for contralateral lobectomy for a metachronous cancer, is increasing. Perioperative outcomes after contralateral lobectomy are unknown. Methods Among patients who underwent contralateral lobectomy for second primary NSCLC during 1995 to 2020, we evaluated 90-day mortality and major morbidity (Clavien-Dindo grades 3-5) rates and their association with clinicopathologic variables, including the year of contralateral lobectomy and duration between lobectomies. Results A total of 98 patients underwent contralateral lobectomy for second primary NSCLC; 51 during an early time period (1995-2009) and 47 from a late time period (2010-2020). There were five mortalities and 23 patients with major morbidities after contralateral lobectomy; both rates decreased in 2010 to 2020 compared with 1995 to 2009 (mortality 10%-0%, major morbidity 35%-11%). Major morbidity was associated with an interval of less than 1 year between lobectomies, a diffusing capacity of the lung for carbon monoxide <80%, and right lower lobe resections. Mortality was associated with squamous cell carcinoma. Patients who underwent contralateral lobectomy for stage I NSCLC had 74% (95% confidence interval: 64%-85%) 3-year overall survival and 15% (95% confidence interval: 6.5%-24%) 3-year lung cancer cumulative incidence of death. Conclusions Contralateral lobectomy for second primary early stage NSCLC was associated with poor outcomes before 2010. Since 2010, perioperative and long-term outcomes of contralateral lobectomy have been comparable with reported outcomes after unilateral lobectomy.
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Affiliation(s)
- Jennie K. Choe
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amy Zhu
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alexander J. Byun
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joe Dycoco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Manjit S. Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew J. Bott
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert J. Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James M. Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Valerie W. Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bernard J. Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R. Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prasad S. Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York,Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, New York,Corresponding author. Address for correspondence: Prasad S. Adusumilli, MD, FACS, Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.
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11
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Qu C, Li R, Ma Z, Han J, Yue W, Aigner C, Casiraghi M, Tian H. Comparison of the perioperative outcomes between robotic-assisted thoracic surgery and video-assisted thoracic surgery in non-small cell lung cancer patients with different body mass index ranges. Transl Lung Cancer Res 2022; 11:1108-1118. [PMID: 35832453 PMCID: PMC9271441 DOI: 10.21037/tlcr-22-137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/16/2022] [Indexed: 11/09/2022]
Abstract
Background Non-small cell lung cancer (NSCLC) is the most common malignancy and one of the most common causes of cancer-related death worldwide. Robotic-assisted thoracic surgery (RATS) has gradually become a prevalent surgical method for patients with NSCLC. Previous studies have found that body mass index (BMI) is associated with postoperative outcomes. This study aimed to investigate the effectiveness of RATS compared to video-assisted thoracic surgery (VATS) in the treatment of NSCLC with different BMI, in terms of perioperative outcomes. Methods The baseline and perioperative data, including BMI, of 849 NSCLC patients who underwent minimally invasive anatomic lung resections from August 2020 to April 2021 were retrospectively collected and analyzed. Propensity score matching analysis was applied to minimize potential bias between the two groups (VATS and RATS), and the perioperative outcomes were compared. Subgroup analysis was subsequently performed. Results Compared to VATS, RATS had more lymph nodes dissected {9 [inter-quartile range (IQR), 6–12] vs. 7 (IQR, 6–10), P<0.001}, a lower estimated bleeding volume [40 (IQR, 30–50) vs. 50 (IQR, 40–60) mL, P<0.001], and other better postoperative outcomes, but a higher cost of hospitalization [¥83,626 (IQR, 77,211–92,686) vs. ¥75,804 (IQR, 66,184–83,693), P<0.001]. Multivariable logistic regression analysis indicated that RATS (P=0.027) and increasing BMI (P=0.030) were associated with a statistically significant reduction in the risk of postoperative complications. Subgroup analysis indicated that the advantages of RATS may be more obvious in patients with a BMI of 24–28 kg/m2, in which the RATS group had more lymph nodes dissected [9 (IQR, 6–12) vs. 7 (IQR, 5–10), P<0.001] and a decreased risk of total postoperative complications [odds ratio (OR), 0.443; 95% confidence interval (CI), 0.212–0.924; P=0.030] compared to the VATS group. Conclusions Both, RATS and VATS can be safely applied for patients with NSCLC. Perioperative outcome parameters indicate advantages for RATS, however at a higher cost of hospitalization. The advantages of RATS might be more obvious in patients with a BMI of 24–28 kg/m2.
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Affiliation(s)
- Chenghao Qu
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Rongyang Li
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zheng Ma
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Jingyi Han
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Weiming Yue
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Monica Casiraghi
- Division of Thoracic Surgery, European Institute of Oncology-IEO IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, Italy
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
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12
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Montagne F, Chaari Z, Bottet B, Sarsam M, Mbadinga F, Selim J, Guisier F, Gillibert A, Baste JM. Long-Term Survival Following Minimally Invasive Lung Cancer Surgery: Comparing Robotic-Assisted and Video-Assisted Surgery. Cancers (Basel) 2022; 14:cancers14112611. [PMID: 35681593 PMCID: PMC9179652 DOI: 10.3390/cancers14112611] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are known to be safe and efficient surgical procedures to treat lung cancer. Both VATS and RATS allow anatomical resection associated with radical lymph node dissection. However, RATS, unlike VATS, allows the thoracic surgeon to mimic an open approach and to perform lung resection. We hypothesized that the technical advantages of RATS, compared with VATS, would allow more precise resection, with “better lymph node dissection” which could increase survival compared to VATS. Nevertheless, VATS, and RATS nodal up-staging are still debated, with conflicting results and in our study, as well as in the medical literature, RATS failed to show its superiority over VATS in resectable non-small cell lung cancer. Abstract Background: Nowadays, video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are known to be safe and efficient surgical procedures to treat early-stage non-small cell lung cancer (NSCLC). We assessed whether RATS increased disease-free survival (DFS) compared with VATS for lobectomy and segmentectomy. Methods: This retrospective cohort study included patients treated for resectable NSCLC performed by RATS or VATS, in our tertiary care center from 2012 to 2019. Patients’ data were prospectively recorded and reviewed in the French EPITHOR database. Primary outcomes were 5-year DFS for lobectomy and 3-year DFS for segmentectomy, compared by propensity-score adjusted difference of Kaplan–Meier estimates. Results: Among 844 lung resections, 436 VATS and 234 RATS lobectomies and 46 VATS and 128 RATS segmentectomies were performed. For lobectomy, the adjusted 5-year DFS was 60.9% (95% confidence interval (CI) 52.9–68.8%) for VATS and 52.7% (95%CI 41.7–63.7%) for RATS, with a difference estimated at −8.3% (−22.2–+4.9%, p = 0.24). For segmentectomy, the adjusted 3-year DFS was 84.6% (95%CI 69.8–99.0%) for VATS and 72.9% (95%CI 50.6–92.4%) for RATS, with a difference estimated at −11.7% (−38.7–+7.8%, p = 0.21). Conclusions: RATS failed to show its superiority over VATS for resectable NSCLC.
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Affiliation(s)
| | - Zied Chaari
- Department of Thoracic and Cardiovascular Surgery, University of Sfax, Habib Bourguiba University Hospital, Sfax 3029, Tunisia;
| | - Benjamin Bottet
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
| | - Frankie Mbadinga
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
| | - Jean Selim
- Department of Anesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France;
- Normandie University, University of Medicine and Pharmacy of Rouen, UNIROUEN, INSERM U1096, FHU REMOD-VHF, F-76183 Rouen, France
| | - Florian Guisier
- Thoracic Oncology and Respiratory Intensive Care Unit, Department of Pneumology, Rouen University Hospital, F-76000 Rouen, France;
- Normandie University, University of Medicine and Pharmacy of Rouen, UNIROUEN, EA4108 LITIS Lab, QuantiF Team and INSERM CIC-CRB 1404, F-76183 Rouen, France
| | - André Gillibert
- Department of Biostatistics, CHU Rouen, F-76000 Rouen, France;
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.); (F.M.)
- Normandie University, University of Medicine and Pharmacy of Rouen, UNIROUEN, INSERM U1096, FHU REMOD-VHF, F-76183 Rouen, France
- Correspondence: ; Tel.: +33-(2)-32888704
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13
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Zhang J, Feng Q, Huang Y, Ouyang L, Luo F. Updated Evaluation of Robotic- and Video-Assisted Thoracoscopic Lobectomy or Segmentectomy for Lung Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:853530. [PMID: 35494020 PMCID: PMC9039645 DOI: 10.3389/fonc.2022.853530] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/02/2022] [Indexed: 02/05/2023] Open
Abstract
Objectives Robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) are the two principal minimally invasive surgical approaches for patients with lung cancer. This study aimed at comparing the long-term and short-term outcomes of RATS and VATS for lung cancer. Methods A comprehensive search for studies that compared RATS versus VATS for lung cancer published until November 31, 2021, was conducted. Data on perioperative outcomes and oncologic outcomes were subjected to meta-analysis. PubMed, Web of Science, and EMBASE were searched based on a defined search strategy to identify eligible studies before November 2021. Results Twenty-six studies comparing 45,733 patients (14,271 and 31,462 patients who underwent RATS and VATS, respectively) were included. The present meta-analysis showed that there were no significant differences in operative time, any complications, tumor size, chest drain duration, R0 resection rate, lymph station, 5-year overall survival, and recurrence rate. However, compared with the VATS group, the RATS group had less blood loss, a lower conversion rate to open, a shorter length of hospital stay, more lymph node dissection, and better 5-year disease-free survival. Conclusions RATS is a safe and feasible alternative to VATS for patients with lung cancer.
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Affiliation(s)
- Jianyong Zhang
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qingbo Feng
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yanruo Huang
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Lanwei Ouyang
- Department of Thoracic Surgery, The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, China
| | - Fengming Luo
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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14
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Donington J, Schumacher L, Yanagawa J. Surgical Issues for Operable Early-Stage Non-Small-Cell Lung Cancer. J Clin Oncol 2022; 40:530-538. [PMID: 34985938 DOI: 10.1200/jco.21.01592] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Surgical care for early stage non-small-cell lung cancer continuously evolves with new procedures, techniques and care pathways. The most obvious recent change was the transition to minimally invasive procedures, but numerous other aspects of care have also been refined to improve safety and tolerability. These care advancements are essential as we move into an era with increased early detection as a result of screening and greater indications for the use of adjuvant and neoadjuvant strategies.
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15
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Comparison of the long-term oncologic outcomes of robotic-assisted and video-assisted thoracoscopic lobectomy for resectable non-small cell lung carcinoma. J Robot Surg 2022; 16:1281-1288. [PMID: 35032309 DOI: 10.1007/s11701-022-01368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
The current oncologic outcomes of robotic-assisted lobectomy compared to video-assisted thoracoscopic lobectomy are currently not well defined. This study compares the overall survival and recurrence-free survival rates between the two approaches for patients with resectable non-small cell lung carcinoma. This is a retrospective review of 200 patients diagnosed with resectable primary lung carcinoma who underwent minimally invasive lobectomy from March 2014 to May 2018. A total of 100 patients underwent thoracoscopic lobectomy and 100 patients underwent robotic-assisted lobectomy by a single surgeon. The data collected included patient demographics, tumor characteristics, surgical margin status, total number of lymph nodes harvested, lymph node upstaging rate, and overall survival and recurrence-free survival. The patients in each group were similar in age, gender, smoking status, pulmonary function, tumor histology, and pathologic stage. The postoperative mortality and complication rates were similar as well. The median number of total lymph nodes and N2 lymph nodes were significantly higher in the robotic lobectomy group (p < 0.0001). The Kaplan-Meier survival rates of overall survival (p = 0.097) and recurrence-free survival (p = 0.769) were similar between the two surgical approaches. The results of this report suggest that thoracoscopic and robotic-assisted lobectomy have similar long-term oncologic outcomes. There may be an advantage for robotic-assisted lobectomy in the total number of lymph nodes harvested during lobectomy.
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16
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Montagne F, Guisier F, Venissac N, Baste JM. The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives-State of the Art. Cancers (Basel) 2021; 13:3711. [PMID: 34359612 PMCID: PMC8345199 DOI: 10.3390/cancers13153711] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 12/25/2022] Open
Abstract
Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the cornerstone treatment when it can be performed. The role of surgery and surgeons has also evolved because surgeons not only perform the initial curative lung cancer resection but they also accompany and follow-up patients from pre-operative rehabilitation, to treatment for recurrences. Surgery is personalized, according to cancer characteristics, including cancer extensions, from pre-invasive and local tumors to locally advanced, metastatic disease, or residual disease after medical treatment, anticipating recurrences, and patients' characteristics. Surgical management is constantly evolving to offer the best oncologic resection adapted to each NSCLC stage. Today, NSCLC can be considered as a chronic disease and surgery is a valuable tool for the diagnosis and treatment of recurrences, and in palliative conditions to relieve dyspnea and improve patients' comfort.
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Affiliation(s)
- François Montagne
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Florian Guisier
- Department of Pneumology, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France;
- Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen, Normandie University, LITIS QuantIF EA4108, 22 Boulevard Gambetta, F-76183 Rouen, France
| | - Nicolas Venissac
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen (UNIROUEN), Normandie University, INSERM U1096, 22 Boulevard Gambetta, F-76000 Rouen, France
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17
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Sesti J, Almaz B, Bell J, Nguyen A, Bamboat Z, Lackey A, Langan RC, Turner AL, Hilden P, Paul S. Impact of postoperative complications on long-term survival after esophagectomy in older adults: A SEER-Medicare analysis. J Surg Oncol 2021; 124:751-766. [PMID: 34223641 DOI: 10.1002/jso.26587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/23/2021] [Accepted: 05/27/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Esophagectomy is a complex procedure associated with a high rate of postoperative complications. It is not clear whether postoperative complications effect long-term survival. Most studies report the results from single institutions. METHODS We examined the Surveillance, Epidemiology and End Results (SEER)-Medicare database to assess whether long-term overall and cancer-specific mortality of patients undergoing esophagectomy for cancer is impacted by postoperative complications. RESULTS Nine hundred and forty patients underwent esophagectomy from 2007 to 2014, of which 50 died, resulting in a cohort of 890 patients. Majority were males (n = 764, 85.8%) with adenocarcinoma of the lower esophagus. Almost 60% of the group had no neoadjuvant therapy. Four hundred and fifty-five patients had no major complications (51.1%), while 285 (32.0%) and 150 (16.9%) patients had one, two, or more major complications, respectively. Overall survival at 90 days was 93.1%. Multivariate analysis of patients followed up for a minimum of 90 days demonstrated that the number of complications was significantly associated with decreased overall survival but no impact on cancer-specific survival. CONCLUSIONS Our population-based analysis with its inherent limitations suggests that patients undergoing esophagectomy who experience complications have worse overall survival but not cancer-specific survival if they survive at least 90 days from the date of surgery.
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Affiliation(s)
- Joanna Sesti
- Thoracic Surgical Services, RWJBarnabas Health, West Orange, New Jersey, USA
| | - Biruk Almaz
- Department of Surgery, RWJBarnabas Health, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Jaimie Bell
- Thoracic Surgical Services, RWJBarnabas Health, West Orange, New Jersey, USA
| | - Andrew Nguyen
- Department of Surgery, RWJBarnabas Health, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Zubin Bamboat
- Department of Surgery, Summit Medical Group, Summit, New Jersey, USA
| | - Adam Lackey
- Thoracic Surgical Services, RWJBarnabas Health, West Orange, New Jersey, USA
| | - Russell C Langan
- Department of Surgery, RWJBarnabas Health, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Amber L Turner
- Department of Surgery, RWJBarnabas Health, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Patrick Hilden
- Department of Biostatistics, RWJBarnabas Health, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Subroto Paul
- Thoracic Surgical Services, RWJBarnabas Health, West Orange, New Jersey, USA.,Department of Surgery, RWJBarnabas Health, Saint Barnabas Medical Center, Livingston, New Jersey, USA
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18
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Jindani R, Lopez MA, Miquel TP, Sylvin E. Robotic Resection of Pulmonary Epithelial Myoepithelial Carcinoma: A Case Report. Thorac Cardiovasc Surg Rep 2021; 10:e42-e44. [PMID: 34194921 PMCID: PMC8236324 DOI: 10.1055/s-0041-1723836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/28/2020] [Indexed: 12/02/2022] Open
Abstract
Background
Pulmonary epithelial–myoepithelial carcinoma (P-EMC) is an extremely rare, well-differentiated, and malignant neoplasm originating from submucosal bronchial glands in the lung. EMCs arise mainly in the salivary glands.
Case Description
This case represents an asymptomatic 78-year-old male with a remote 75-pack-year history of smoking who presents with a solitary endobronchial lesion, which is suggestive of a primary lung EMC, detected on annual screening chest computed tomography (CT) scan.
Conclusion
A recent review of literature reveals less than 50 documented cases of the pulmonary subtype of this tumor worldwide. We are reporting a unique case of robot-assisted pulmonary lobectomy for a P-EMC.
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Affiliation(s)
- Rajika Jindani
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Michael A Lopez
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Thoracic Surgery, JFK Medical Center, Atlantis, Florida, United States
| | - Tatiana P Miquel
- Department of Pathology, JFK Medical Center, Atlantis, Florida, United States
| | - Erik Sylvin
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Thoracic Surgery, JFK Medical Center, Atlantis, Florida, United States
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19
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Wu H, Jin R, Yang S, Park BJ, Li H. Long-term and short-term outcomes of robot- versus video-assisted anatomic lung resection in lung cancer: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2021; 59:732-740. [PMID: 33367615 DOI: 10.1093/ejcts/ezaa426] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/10/2020] [Accepted: 10/22/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Minimally invasive thoracic surgery has evolved with the introduction of robotic platforms. This study aimed to compare the long-term and short-term outcomes of the robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for anatomic lung resection. METHODS We searched published studies that investigated RATS and VATS in anatomic lung resection. Long-term outcomes (disease-free survival and overall survival) and short-term outcomes (30-day mortality, postoperative complications, conversion rate to open surgery and lymph node upstaging) were extracted. The features were compared and tested as hazard ratios (HRs) and odds ratios (ORs) at a 95% confidence interval (CI). RESULTS Twenty-five studies with 50 404 patients (7135 for RATS and 43 269 for VATS) were included. The RATS group had a longer disease-free survival than the VATS group (HR: 0.76; 95% CI: 0.59-0.97; P = 0.03), and the overall survival showed a similar trend but was not statistically significant (HR: 0.77; 95% CI: 0.57-1.05; P = 0.10). The RATS group showed a significantly lower 30-day mortality (OR: 0.55; 95% CI: 0.38-0.81; P = 0.002). No significant difference was found in postoperative complications (OR: 1.01; 95% CI: 0.87-1.16; P = 0.94), the conversion rate to open surgery (OR: 0.92; 95% CI: 0.56-1.52; P = 0.75) and lymph node upstaging (OR: 0.89; 95% CI: 0.52-1.54; P = 0.68). CONCLUSIONS RATS has comparable short-term outcomes and potential long-term survival benefits for anatomic lung resection compared with VATS.
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Affiliation(s)
- Han Wu
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Runsen Jin
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Su Yang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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20
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Langzeitprognose nach thorakoskopischer versus roboterassistierter Lobektomie. Zentralbl Chir 2021. [DOI: 10.1055/a-1317-3770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Chen D, Kang P, Tao S, Li Q, Wang R, Tan Q. Cost-effectiveness evaluation of robotic-assisted thoracoscopic surgery versus open thoracotomy and video-assisted thoracoscopic surgery for operable non-small cell lung cancer. Lung Cancer 2021; 153:99-107. [PMID: 33482409 DOI: 10.1016/j.lungcan.2020.12.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/14/2020] [Accepted: 12/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aimed to evaluate the cost-effectiveness of robotic-assisted thoracoscopic surgery (RATS) over open thoracotomy (OT) and video-assisted thoracoscopic surgery (VATS) for operable non-small cell lung cancer (NSCLC) from the perspective of Chinese healthcare payer. METHODS The Markov decision model was developed to assess the 5-year costs and quality-adjusted life year (QALY) of RATS versus OT and VATS for operable NSCLC patients. The propensity-matched cohorts were generated from our clinical center to determine the surgical costs and complication rates. An individual patient data meta-analysis was conducted to estimate model probabilities of progression and survival risks. Other model inputs were abstracted from available studies. The primary outcome was incremental cost-effectiveness ratios (ICERs). RESULTS RATS contributed to an incremental 0.28 QALYs at an additional cost of $3,104.82, making for an ICER of $10,967.41 per QALY versus OT. Robotic approach harvested an incremental 0.05 QALYs at an additional cost of $4006.86, making for an ICER of $80324.98 per QALY over VATS. RATS shown a same cost-effectiveness probability (0.50) versus OT and VATS at a willing-to-pay (WTP) threshold of $12,000 per QALY and $75,800 per QALY, respectively. The probabilities of cost-effectiveness for RATS were 0.64 and 0.21 at a presupposed WTP threshold of $ 30,000 per QALY versus OT and VATS, respectively. CONCLUSIONS RATS was evaluated to be cost-effective versus OT for patients with operable NSCLC from the perspective of Chinese healthcare payer. To the contrary, robotic approach was associated with less cost-effective than VATS.
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Affiliation(s)
- Dali Chen
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Poming Kang
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Shaolin Tao
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Qingyuan Li
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Ruwen Wang
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Qunyou Tan
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China.
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