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Casiraghi M, Cara A, Mazzella A, Girelli L, Lo Iacono G, Uslenghi C, Caffarena G, Orlandi R, Bertolaccini L, Maisonneuve P, Spaggiari L. 1000 Robotic-assisted lobectomies for primary lung cancer: 16 years single center experience. Lung Cancer 2024; 195:107903. [PMID: 39096647 DOI: 10.1016/j.lungcan.2024.107903] [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: 05/08/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVE This study aimed at describing our high-volume single center experience in robotic-assisted thoracic surgery (RATS) to evaluate short outcome and feasibility of the technique, the adequacy of oncological results, and the learning curve. METHODS We retrospectively analyzed data from 1000 consecutive patients who underwent lobectomy and systematic lymphadenectomy for primary lung cancer using RATS approach between May 2007 and May 2023. RESULTS Nine-hundred ninety-seven patients (99.7 %) underwent lobectomy, whereas 3 (0.03 %) patients bilobectomy. Conversion rate to open surgery was 3.7 %. Minor complications occurred in 213 (21.3 %) patients, major complications in 29 patients (2.9 %). The 30-day and 90-day operative mortality was 0 % and 0.1 %, respectively. The median number of N1 + N2 stations resected was 5 (range 0-9), with a median number of 17 of N1 + N2 lymph nodes resected (range 0-55). The oncological outcome was evaluated only on the subgroup of patients (n = 895) with non-small cell lung cancer. Pathological lymph node upstaging from cN0 to pN1/pN2 was evident in 147 patients (17.3 %): 9 % from cN0 to pN1 and 7.1 % from cN0 to pN2. With a median follow-up of 3.9, 5-year OS and DFS were respectively 89.3 % and 83.6 % for stage I, 74 % and 66.5 % for stage II, and 61 % and 36.4 % for stage IIIA. CONCLUSIONS Better vision and excellent instrument maneuverability of the robotic surgical system allowed excellent results in terms of early, adequate oncological outcome comparable to open surgery literature data, and acceptable learning curve. ULTRAMINI ABSTRACT 1000 consecutive patients who underwent lobectomy and systematic lymphadenectomy for primary lung cancer using RATS approach have been analyzed with the aim to describe our high-volume single center experience, and to evaluate short outcome and feasibility of the technique, the adequacy of oncological results, and the learning curve.
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Affiliation(s)
- Monica Casiraghi
- Department of Thoracic Surgery, IEO-European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Italy.
| | - Andrea Cara
- Department of Thoracic Surgery, IEO-European Institute of Oncology IRCCS, Milan, Italy
| | - Antonio Mazzella
- Department of Thoracic Surgery, IEO-European Institute of Oncology IRCCS, Milan, Italy
| | - Lara Girelli
- Department of Thoracic Surgery, IEO-European Institute of Oncology IRCCS, Milan, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO-European Institute of Oncology IRCCS, Milan, Italy
| | - Clarissa Uslenghi
- Department of Thoracic Surgery, IEO-European Institute of Oncology IRCCS, Milan, Italy
| | - Giovanni Caffarena
- Department of Thoracic Surgery, IEO-European Institute of Oncology IRCCS, Milan, Italy
| | - Riccardo Orlandi
- Department of Thoracic Surgery, IEO-European Institute of Oncology IRCCS, Milan, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO-European Institute of Oncology IRCCS, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO-European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO-European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Italy
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Ureña A, Moreno C, Macia I, Rivas F, Déniz C, Muñoz A, Serratosa I, García M, Masuet-Aumatell C, Escobar I, Ramos R. A Comparison of Total Thoracoscopic and Robotic Surgery for Lung Cancer Lymphadenectomy. Cancers (Basel) 2023; 15:3442. [PMID: 37444555 DOI: 10.3390/cancers15133442] [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: 05/17/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Robotic-assisted thoracic surgery (RATS) is used increasingly frequently in major lung resection for early stage non-small-cell lung cancer (NSCLC) but has not yet been fully evaluated. The aim of this study was to compare the surgical outcomes of lymph node dissection (LND) performed via RATS with those from totally thoracoscopic (TT) four-port videothoracoscopy. METHODS Clinical and pathological data were collected retrospectively from patients with clinical stage N0 NSCLC who underwent pulmonary resection in the form of lobectomy or segmental resection between June 2010 and November 2022. The assessment criteria were number of mediastinal lymph nodes and number of mediastinal stations dissected via the RATS approach compared with the four-port TT approach. RESULTS A total of 246 pulmonary resections with LND for clinical stages I-II NSCLC were performed: 85 via TT and 161 via RATS. The clinical characteristics of the patients were similar in both groups. The number of mediastinal nodes dissected and mediastinal stations dissected was significantly higher in the RATS group (TT: mean ± SD, 10.72 ± 3.7; RATS, 14.74 ± 6.3 [p < 0.001]), except in the inferior mediastinal stations. There was no difference in terms of postoperative complications. CONCLUSIONS In patients with early stage NSCLC undergoing major lung resection, the quality of hilomediastinal LND performed using RATS was superior to that performed using TT.
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Affiliation(s)
- Anna Ureña
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Department of Thoracic Surgery, Hospital Clinic, 08036 Barcelona, Spain
| | - Camilo Moreno
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Doctoral Programme of Medicine and Translational Research, University of Barcelona, 08036 Barcelona, Spain
| | - Ivan Macia
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Francisco Rivas
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Carlos Déniz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Anna Muñoz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ines Serratosa
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Marta García
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Cristina Masuet-Aumatell
- Department of Preventive Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ignacio Escobar
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ricard Ramos
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Department of Thoracic Surgery, Hospital Clinic, 08036 Barcelona, Spain
- Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
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Moreno C, Ureña A, Macia I, Rivas F, Déniz C, Muñoz A, Serratosa I, Poltorak V, Moya-Guerola M, Masuet-Aumatell C, Escobar I, Ramos R. The Influence of Preoperative Nutritional and Systemic Inflammatory Status on Perioperative Outcomes following Da Vinci Robot-Assisted Thoracic Lung Cancer Surgery. J Clin Med 2023; 12:jcm12020554. [PMID: 36675482 PMCID: PMC9863584 DOI: 10.3390/jcm12020554] [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: 12/03/2022] [Revised: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Background: Nutrition is an important factor in the outcome of any disease process. We evaluated the relationship of nutritional status and inflammatory status of non-small cell lung cancer (NSCLC) patients undergoing robotic-assisted thoracic surgery (RATS) with postoperative complications. Methods: This prospective cohort study included 107 NSCLC patients undergoing surgical treatment, between 2019 and 2021. Nutritional status and inflammatory status were assessed before pulmonary resection using anthropometric assessment, blood tests, and body mass index (BMI). Results: The BMI was 27.5 ± 4.4. Based on BMI, 29% (n = 31) were classified as normal weight, 43% (n = 46) as overweight, and 28% (n = 30) as obese. The mean neutrophil/lymphocyte ratio (NLR) was 2.16 ± 0.85, the platelet/lymphocyte ratio (PLR) was 121.59 ± 44.21, and the lymphocyte/monocyte ratio (LMR) was 3.52 ± 1.17. There was no increase in the number of intraoperative complications or bleeding (p = 0.696), postoperative complications (p = 0.569), mean hospital stay (p = 0.258) or duration of chest drain (p = 0.369). Higher inflammatory status, with an NLR > 1.84, was associated with more overall postoperative complications (p = 0.028), only in univariate analysis, but this significance was not maintained on multivariate analysis. Conclusions: BMI was not a predictor of increased postoperative risk in this cohort; therefore, weight should not deter surgeons from using RATS for pulmonary resection.
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Affiliation(s)
- Camilo Moreno
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Anna Ureña
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ivan Macia
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Francisco Rivas
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Carlos Déniz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Anna Muñoz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ines Serratosa
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Violeta Poltorak
- Department of Preventive Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Miguel Moya-Guerola
- Department of Preventive Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Cristina Masuet-Aumatell
- Department of Preventive Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ignacio Escobar
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ricard Ramos
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
- Correspondence: ; Tel.: +34-933-357-011
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Pan H, Gu Z, Tian Y, Jiang L, Zhu H, Ning J, Huang J, Luo Q. Propensity score-matched comparison of robotic- and video-assisted thoracoscopic surgery, and open lobectomy for non-small cell lung cancer patients aged 75 years or older. Front Oncol 2022; 12:1009298. [PMID: 36185241 PMCID: PMC9525021 DOI: 10.3389/fonc.2022.1009298] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/31/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Although robot-assisted thoracoscopic surgery (RATS) has been widely applied in treating non-small cell lung cancer (NSCLC), its advantages remain unclear for very old patients. The present study compared the perioperative outcomes and survival profiles among RATS, video-assisted thoracoscopic surgery (VATS), and open lobectomy (OL), aiming to access the superiority of RATS for NSCLC patients aged ≥75 years. Methods Pathological IA-IIIB NSCLC patients aged ≥75 years who underwent RATS, VATS, or OL between June 2015 and June 2021 in Shanghai Chest Hospital were included. Propensity score matching (PSM, 1:1:1 RATS versus VATS versus OL) was based on 10 key prognostic factors. The primary endpoints were perioperative outcomes, and the secondary endpoints were disease-free (DFS), overall (OS), and cancer-specific survival (CS). Results A total of 504 cases (126 RATS, 200 VATS, and 178 OL) were enrolled, and PSM led to 97 cases in each group. The results showed that RATS led to: 1) the best surgical-related outcomes including the shortest operation duration (p <0.001) and the least blood loss (p <0.001); 2) the fastest postoperative recoveries including the shortest ICU stay (p = 0.004), chest tube drainage duration (p <0.001), and postoperative stay (p <0.001), and the most overall costs (p <0.001); 3) the lowest incidence of postoperative complications (p = 0.002), especially pneumonia (p <0.001). There was no difference in the resection margins, reoperation rates, intraoperative blood transfusion, and volume of chest tube drainage among the three groups. Moreover, RATS assessed more N1 (p = 0.009) and total (p = 0.007) lymph nodes (LNs) than VATS, while the three surgical approaches dissected similar numbers of N1, N2, and total LN stations and led to a comparable incidence of postoperative nodal upstaging. Finally, the three groups possessed comparable DFS, OS, and CS rates. Further subgroup analysis found no difference in DFS or OS among the three groups, and multivariable analysis showed that the surgical approach was not independently correlated with survival profiles. Conclusion RATS possessed the superiority in achieving better perioperative outcomes over VATS and OL in very old NSCLC patients, though the three surgical approaches achieved comparable survival outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Jia Huang
- *Correspondence: Jia Huang, ; Qingquan Luo,
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Applications of Robotic Surgery in Thoracic Diseases. J Clin Med 2022; 11:jcm11144201. [PMID: 35887965 PMCID: PMC9317933 DOI: 10.3390/jcm11144201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
With the ever-expanding implement of screening programs, as well as a raised awareness of patients about their own health, the number of cases of early-stage lung cancer is progressively increasing, leading surgeons to adapt their practice and to develop new surgical techniques that are less and less invasive [...]
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Long-Term Outcomes of Robotic-Assisted, Video-Assisted and Open Surgery in Non-Small Cell Lung Cancer: A Matched Analysis. J Clin Med 2022; 11:jcm11123363. [PMID: 35743434 PMCID: PMC9225497 DOI: 10.3390/jcm11123363] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION This study makes a comparison between stage I non-small cell lung cancer (NSCLC) patients subjected to either robotic-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS) or open thoracotomy, with the aim to evaluate differences between these three approaches in terms of oncological outcomes. METHOD We reviewed data from 1367 consecutive patients who, between 2011 and 2017, underwent lobectomy for NSCLC with either open surgery, VATS or RATS, and performed a matched case-control study based on patients' age, gender, clinical stage (IA, IB) and ASA score. RESULTS 180 patients (n = 72 RATS, n = 36 VATS, n = 72 open) were analyzed. Complication rates were found to be comparable (72.2% open, 86.1% VATS, 81.9% RATS), with similar grades of severity. The median number of resected lymph nodes was higher in open surgery (n = 22) than in VATS (n = 15; p = 0.0001) and in RATS (n = 17; p = 0.004). Pathological N2 upstaging was higher in open surgery (9.7%) compared to VATS (5.6%) and RATS (5.6%). However, the recurrence rate in VATS was significantly higher than in RATS (log rank p = 0.03). No statistically significant differences were detected in 5-year OS and cancer-specific survival. CONCLUSIONS no differences were found in OS and cancer-specific survival between VATS, RATS and open lobectomy for stage I NSCLC patients; even if in VATS, the incidence of recurrences, in particular local recurrences, was higher than in RATS and in open surgery.
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Gallina FT, Tajè R, Forcella D, Corzani F, Cerasoli V, Visca P, Coccia C, Pierconti F, Sperduti I, Cecere FL, Cappuzzo F, Melis E, Facciolo F. Oncological Outcomes of Robotic Lobectomy and Radical Lymphadenectomy for Early-Stage Non-Small Cell Lung Cancer. J Clin Med 2022; 11:jcm11082173. [PMID: 35456265 PMCID: PMC9025272 DOI: 10.3390/jcm11082173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 12/14/2022] Open
Abstract
Background: While the thoracotomy approach was considered the gold standard until two decades ago, robotic surgery has increasingly strengthened its role in lung cancer treatment, improving patients’ peri-operative outcomes. In this study, we report our experience in robotic lobectomy for early-stage non-small cell lung cancer, with particular attention to oncological outcomes and nodal upstaging rate. Methods: We retrospectively reviewed patients who underwent lobectomy and radical lymphadenectomy at our Institute between 2016 and 2020. We selected 299 patients who met the inclusion criteria of the study. We analyzed the demographic features of the groups as well as their nodal upstaging rate after pathological examination. Then, we analyzed disease-free and overall survival of the entire enrolled patient population and we compared the same oncological outcomes in the upstaging and the non-upstaging group. Results: A total of 299 patients who underwent robotic lobectomy were enrolled. After surgery, 55 patients reported nodal hilar or mediastinal upstaging. The 3-year overall survival of the entire population was 82.8%. The upstaging group and the non-upstaging group were homogeneous for age, gender, smoking habits, clinical stage, tumor site, tumor histology. The non-upstaging group had better OS (p = 0.004) and DFS (p < 0.0001). Conclusion: Our results show that robotic surgery is a safe and feasible approach for the treatment of early-stage NSCLC, especially for its accuracy in mediastinal lymphadenectomy. The oncological outcomes were encouraging and consistent with previous findings.
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Affiliation(s)
- Filippo Tommaso Gallina
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (R.T.); (D.F.); (F.C.); (V.C.); (E.M.); (F.F.)
- Correspondence: ; Tel.: +39-0652665218
| | - Riccardo Tajè
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (R.T.); (D.F.); (F.C.); (V.C.); (E.M.); (F.F.)
| | - Daniele Forcella
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (R.T.); (D.F.); (F.C.); (V.C.); (E.M.); (F.F.)
| | - Felicita Corzani
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (R.T.); (D.F.); (F.C.); (V.C.); (E.M.); (F.F.)
| | - Virna Cerasoli
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (R.T.); (D.F.); (F.C.); (V.C.); (E.M.); (F.F.)
| | - Paolo Visca
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Cecilia Coccia
- Anesthesiology and Intensive Care Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.C.); (F.P.)
| | - Federico Pierconti
- Anesthesiology and Intensive Care Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.C.); (F.P.)
| | - Isabella Sperduti
- Biostatistics, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | | | - Federico Cappuzzo
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Enrico Melis
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (R.T.); (D.F.); (F.C.); (V.C.); (E.M.); (F.F.)
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (R.T.); (D.F.); (F.C.); (V.C.); (E.M.); (F.F.)
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Park JH, Park S, Kang CH, Na BS, Bae SY, Na KJ, Lee HJ, Park IK, Kim YT. Early Outcomes of Robotic Versus Video-Assisted Thoracoscopic Anatomical Resection for Lung Cancer. J Chest Surg 2022; 55:49-54. [PMID: 35115422 PMCID: PMC8824642 DOI: 10.5090/jcs.21.128] [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: 10/14/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background We compared the safety and effectiveness of robotic anatomical resection and video-assisted thoracoscopic surgery (VATS). Methods A retrospective analysis was conducted of the records of 4,283 patients, in whom an attempt was made to perform minimally invasive anatomical resection for lung cancer at Seoul National University Hospital from January 2011 to July 2020. Of these patients, 138 underwent robotic surgery and 4,145 underwent VATS. Perioperative outcomes were compared after propensity score matching including age, sex, height, weight, pulmonary function, smoking status, performance status, comorbidities, type of resection, combined bronchoplasty/angioplasty, tumor size, clinical T/N category, histology, and neoadjuvant treatment. Results In total, 137 well-balanced pairs were obtained. There were no cases of 30-day mortality in the entire cohort. Conversion to thoracotomy was required more frequently in the VATS group (VATS 6.6% vs. robotic 0.7%, p=0.008). The complete resection rate (VATS 97.8% vs. robotic 98.5%, p=1.000) and postoperative complication rate (VATS 17.5% vs. robotic 19.0%, p=0.874) were not significantly different between the 2 groups. The robotic group showed a slightly shorter hospital stay (VATS 5.8±3.9 days vs. robotic 5.0±3.6 days, p=0.052). N2 nodal upstaging (cN0/pN2) was more common in the robotic group than the VATS group, but without statistical significance (VATS 4% vs. robotic 12%, p=0.077). Conclusion Robotic anatomical resection in lung cancer showed comparable early outcomes when compared to VATS. In particular, robotic resection presented a lower conversion-to-thoracotomy rate. Furthermore, a robotic approach might improve lymph node harvesting in the N2 station.
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Affiliation(s)
- Ji Hyeon Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bub Se Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - So Young Bae
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Joo Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Haruki T, Takagi Y, Kubouchi Y, Kidokoro Y, Nakanishi A, Nozaka Y, Oshima Y, Matsui S, Nakamura H. Comparison between robot-assisted thoracoscopic surgery and video-assisted thoracoscopic surgery for mediastinal and hilar lymph node dissection in lung cancer surgery. Interact Cardiovasc Thorac Surg 2021; 33:409-417. [PMID: 34297835 DOI: 10.1093/icvts/ivab112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/01/2021] [Accepted: 03/26/2021] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Lymph node dissection (LND) with robot-assisted thoracoscopic surgery (RATS) in lung cancer surgery has not been fully evaluated. The aim of this study was to compare LND surgical results between video-assisted thoracoscopic surgery (VATS) and RATS. METHODS We retrospectively compared perioperative parameters, including the incidence of LND-associated complications (chylothorax, recurrent and/or phrenic nerve paralysis and bronchopleural fistula), lymph node (LN) counts and postoperative locoregional recurrence, among 390 patients with primary lung cancer who underwent lobectomy and mediastinal LND by RATS (n = 104) or VATS (n = 286) at our institution. RESULTS The median total dissected LN numbers significantly differed between the RATS and the VATS groups (RATS: 18, VATS: 15; P < 0.001). They also significantly differed in right upper zone and hilar (#2R + #4R + #10L) (RATS: 12, VATS: 10; P = 0.002), left lower paratracheal and hilar (#4L + #10L) (RATS: 4, VATS: 3; P = 0.019), aortopulmonary zone (#5 + #6) (RATS: 3, VATS: 2; P = 0.001) and interlobar and lobar (#11 + #12) LNs (RATS: 7, VATS: 6; P = 0.041). The groups did not significantly differ in overall nodal upstaging (P = 0.64), total blood loss (P = 0.69) or incidence of LND-associated complications (P = 0.77). CONCLUSIONS In this comparison, it was suggested that more LNs could be dissected using RATS than VATS, especially in bilateral superior mediastinum and hilar regions. Accumulation of more cases and longer observation periods are needed to verify whether RATS can provide the acceptable quality of LND and local control of lung cancer.
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Affiliation(s)
- Tomohiro Haruki
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yuzo Takagi
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yasuaki Kubouchi
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yoshiteru Kidokoro
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Atsuyuki Nakanishi
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yuji Nozaka
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yuki Oshima
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Shinji Matsui
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Hiroshige Nakamura
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
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Robotic-Assisted versus Video-Assisted Thoracoscopic Lobectomy: Short-Term Results of a Randomized Clinical Trial (RVlob Trial). Ann Surg 2021; 275:295-302. [PMID: 33938492 DOI: 10.1097/sla.0000000000004922] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether robotic-assisted lobectomy (RAL) affects perioperative outcomes and long-term efficacy in non-small cell lung cancer (NSCLC) patients, compared with traditional video-assisted lobectomy (VAL). SUMMARY BACKGROUND DATA RAL is a promising treatment for NSCLC. However, its efficacy has not been fully evaluated. METHODS A single-center, open-labeled prospective randomized clinical trial was launched in May 2017 to compare the efficacy of RAL and VAL. By May 2020, 320 patients were enrolled. The perioperative results of RAL and VAL were compared. RESULTS The 320 enrolled patients were randomly assigned to the RAL group (n = 157) and the VAL group (n = 163). Perioperative outcomes were comparable between the two groups, including the length of hospital stay (P = 0.76) and the rate of postoperative complications (P = 0.45). No perioperative mortality occurred in either group. The total amount of chest tube drainage (830 ml [IQR, 550-1130 ml] vs. 685 ml [IQR, 367.5-1160 ml], P = 0.007) and hospitalization costs ($12821 [IQR, $12145-$13924] vs. $8009 [IQR, $7014-$9003], P < 0.001) were significantly higher in the RAL group. RAL group had a significantly higher number of lymph nodes (LNs) harvested (11 [IQR, 8-15] vs. 10 [IQR, 8-13], P = 0.02), higher number of N1 LNs (6 [IQR, 4-8] vs. 5 [IQR, 3-7], P = 0.005), and more LN stations examined (6 [IQR, 5-7] vs. 5 [IQR, 4-6], P < 0.001). CONCLUSIONS Both RAL and VAL are safe and feasible for the treatment of NSCLC. RAL achieved similar perioperative outcomes, together with higher LN yield. Further follow-up investigations are required to evaluate the long-term efficacy of RAL. (ClinicalTrials.gov identifier: NCT03134534).
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11
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Shahin GM, Topal B, Pouwels S, Markou TL, Boon R, Stigt JA. Quality assessment of robot assisted thoracic surgical resection of non-small cell lung cancer: nodal upstaging and mediastinal recurrence. J Thorac Dis 2021; 13:592-599. [PMID: 33717532 PMCID: PMC7947478 DOI: 10.21037/jtd-20-2267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Robot assisted thoracic surgery (RATS) is the minimally invasive surgical technique of choice for treatment of patients with non-small cell lung cancer (NSCLC), at the Isala Hospital. The aim of this study is to compare clinical and pathological staging results and mediastinal recurrence after RATS for anatomical resections of lung cancer as surrogate markers for quality of mediastinal lymph node dissection (MLND). Methods This single institute retrospective study was conducted in patients who underwent RATS for NSCLC. Excluded were patients with a history of concurrent malignant disease, with other previous neoplasms, with small cell lung cancer (SCLC) and patients in whom the robotic technique was converted to thoracotomy, prior to lymph node dissection. Data were obtained from the hospital database. The difference between clinical and pathological staging was expressed as upstaging and downstaging. Computed Tomography scanning was used for follow-up, and diagnosis of mediastinal recurrence. Results From November 2011 to May 2016, 227 patients underwent RATS at Isala Hospital Zwolle, the Netherlands. Of those, 130 (mean age, 69.5±9.3 years) met the eligibility criteria. Preoperative mediastinal lymph node staging was done by endoscopic ultrasound/endobronchial ultrasound, by positron emission tomography (PET) or mediastinoscopy. In 14 patients (10.8%) unforeseen N2 disease was found, 6 patients (4.6%) were upstaged from cN0 to pN2 and 8 patients (6.2%) were upstaged from cN1 to pN2. Mediastinal recurrence was detected in 7 patients (5.4%) during a median follow-up of 54 months (range, 1.5-102 months). Conclusions In patients with NSCLC, who underwent anatomical resection by means of RATS, an unforeseen N2 disease rate of 10.8% was demonstrated and a mediastinal recurrence rate of 5.4%. It is concluded that robotic surgery provides an accurate lymph node dissection.
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Affiliation(s)
- Ghada M Shahin
- Department of Cardiothoracic Surgery, Isala Heart Center, Zwolle, The Netherlands
| | - Besir Topal
- Department of Cardiothoracic Surgery, Isala Heart Center, Zwolle, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Thanasie L Markou
- Department of Cardiothoracic Surgery, Isala Heart Center, Zwolle, The Netherlands
| | - Rody Boon
- Department of Cardiothoracic Surgery, Isala Heart Center, Zwolle, The Netherlands
| | - Jos A Stigt
- Department of Pulmonology, Isala, Zwolle, The Netherlands
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Dezube AR, Jaklitsch MT. Minimizing residual occult nodal metastasis in NSCLC: recent advances, current status and controversies. Expert Rev Anticancer Ther 2020; 20:117-130. [PMID: 32003589 DOI: 10.1080/14737140.2020.1723418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Nodal involvement in lung cancer is a significant determinant of prognosis and treatment management. New evidence exists regarding the management of occult lymph node metastasis and residual disease in the fields of imaging, mediastinal staging, and operative management.Areas covered: This review summarizes the latest body of knowledge on the identification and management of occult lymph node metastasis in NSCLC. We focus on tumor-specific characteristics; imaging modalities; invasive mediastinal staging; and operative management including, technique, degree of resection, and lymph node examination.Expert opinion: Newly identified risk-factors associated with nodal metastasis including tumor histology, location, radiologic features, and metabolic activity are not included in professional societal guidelines due to the heterogeneity of their reporting and uncertainty on how to adopt them into practice. Imaging as a sole diagnostic method is limited. We recommend confirmation with invasive mediastinal staging. EBUS-FNA is the best initial method, but adoption has not been uniform. The diagnostic algorithm is less certain for re-staging of mediastinal nodes after neoadjuvant therapy. Mediastinal node sampling during lobectomy remains the gold-standard, but evidence supports the use of minimally invasive techniques. More study is warranted regarding sublobar resection. No consensus exists regarding lymph node examination, but new evidence supports reexamination of current quality metrics.
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Affiliation(s)
- Aaron R Dezube
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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13
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Casiraghi M, Sedda G, Diotti C, Mariolo AV, Galetta D, Tessitore A, Maisonneuve P, Spaggiari L. Postoperative outcomes of robotic-assisted lobectomy in obese patients with non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2019; 30:359-365. [DOI: 10.1093/icvts/ivz273] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 12/30/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to assess the postoperative outcomes of robotic-assisted lobectomy in obese patients to determine the impact of the robotic approach on a high-risk population who were candidates for major pulmonary resection for non-small-cell lung cancer (NSCLC).
METHODS
Between January 2007 and August 2018, we retrospectively reviewed the medical records of 224 obese patients (body mass index ≥ 30) who underwent pulmonary lobectomy at our institution via robotic-assisted thoracic surgery (RATS, n = 51) or lateral muscle-sparing thoracotomy (n = 173).
RESULTS
Forty-two patients were individually matched with those who had the same pathological tumour stage and similar comorbidities and presurgical treatment. The median operative time was significantly longer in the RATS group compared to that in the thoracotomy group (200 vs 158 min; P = 0.003), whereas the length of stay was significantly better for the RATS group (5 vs 6 days; P = 0.047). Postoperative complications were significantly more frequent after open lobectomy than in the RATS group (42.9% vs 16.7%; P = 0.027). After a median follow-up of 4.4 years, the 5-year overall survival rate was 67.6% [95% confidence interval (CI) 45.7–82.2] for the RATS group, and 66.1% (95% CI 46.8–79.9) for the open surgery group (log-rank P = 0.54). The 5-year cumulative incidence of cancer-related deaths was 24.8% (95% CI 9.7–43.5) for the RATS group and 23.6% (95% CI 10.8–39.2) for the open surgery group (Gray’s test, P = 0.69).
CONCLUSIONS
RATS is feasible and safe for obese patients with NSCLC with advantages compared to open surgery in terms of early postoperative outcomes. In addition, the long-term survival rate was comparable to that of the open approach.
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Affiliation(s)
- Monica Casiraghi
- Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, University of Milan, Milan, Italy
| | - Giulia Sedda
- Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, University of Milan, Milan, Italy
| | - Cristina Diotti
- Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, University of Milan, Milan, Italy
| | - Alessio Vincenzo Mariolo
- Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, University of Milan, Milan, Italy
| | - Domenico Galetta
- Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, University of Milan, Milan, Italy
| | - Adele Tessitore
- Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, University of Milan, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, University of Milan, Milan, Italy
- Department of Oncology and Hematology (DIPO), School of Medicine, University of Milan, Milan, Italy
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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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15
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Porkhanov VA, Danilov VV, Polyakov IS, Kononenko VB, Zhikharev VA, Krygin SA. [Minimally invasive thoracoscopic and robot-assisted lobectomy]. Khirurgiia (Mosk) 2019:46-52. [PMID: 31464274 DOI: 10.17116/hirurgia201908146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the early outcomes of video-assisted and robot-assisted lobectomy. MATERIAL AND METHODS There were 74 robot-assisted lung resections for the period 2017-2018. Sixty-six patients underwent lobectomy and 8 - segmentectomy. Patients were divided into 2 groups to compare thoracoscopic procedures. The main group consisted of 66 patients after robot-assisted lobectomy. The control group included 247 patients after video-assisted lobectomy. Mean age of patients was 60.5 years (range 35-70). There 72% men and 28% women. CONCLUSION Both thoracoscopic procedures are characterized by high efficiency and safety. However, certain disadvantages are peculiar to both methods.
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Affiliation(s)
- V A Porkhanov
- Research Institute - Ochapovsky Regional Clinical Hospital, Krasnodar, Russia
| | - V V Danilov
- Research Institute - Ochapovsky Regional Clinical Hospital, Krasnodar, Russia
| | - I S Polyakov
- Research Institute - Ochapovsky Regional Clinical Hospital, Krasnodar, Russia
| | - V B Kononenko
- Research Institute - Ochapovsky Regional Clinical Hospital, Krasnodar, Russia
| | - V A Zhikharev
- Research Institute - Ochapovsky Regional Clinical Hospital, Krasnodar, Russia
| | - S A Krygin
- Research Institute - Ochapovsky Regional Clinical Hospital, Krasnodar, Russia
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16
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Propensity-score adjusted comparison of pathologic nodal upstaging by robotic, video-assisted thoracoscopic, and open lobectomy for non-small cell lung cancer. J Thorac Cardiovasc Surg 2019; 158:1457-1466.e2. [PMID: 31623811 DOI: 10.1016/j.jtcvs.2019.06.113] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the effectiveness of intraoperative lymph node (LN) staging by comparing upstaging between robotic-assisted surgery, video-assisted thoracoscopic surgery (VATS), and open thoracotomy approach for lobectomy for non-small cell lung cancer. METHODS We retrospectively analyzed 1053 patients with clinical stage N0/N1 non-small cell lung cancer who underwent lobectomy at 2 centers between 2011 and 2018. Propensity score adjustment by inverse probability of treatment weighting was used to balance baseline characteristics. The primary end point was LN upstaging. RESULTS A total of 911 patients (254 robotic, 296 VATS, and 261 open) were included in the inverse probability of treatment weighting adjusted analysis. The overall rate of LN upstaging was highest with open lobectomy (21.8%), followed by robotic (16.2%), and VATS (12.3%) (P = .03). Mediastinal N2 upstaging was observed in similar frequencies (open 6.9% vs robotic 6.3% vs VATS 4.4%; P = .6). No differences were seen for total LN counts, but were observed in the number of stations sampled (mean, open 4.0 vs robotic 3.8 vs VATS 3.6; P = .001). On multivariate analysis, LN upstaging was lower for VATS compared with open (odds ratio, 0.50; 95% confidence interval, 0.29-0.85), but not different between robotic and open (odds ratio, 0.72; 95% confidence interval, 0.44-1.18). No significant differences were seen in mediastinal N2 upstaging between groups. CONCLUSIONS Pathologic LN upstaging following lobectomy for clinically N0/N1 NSCLC remains high. Compared with a traditional thoracotomy approach, robotic lobectomy was associated with similar and VATS with lower overall nodal upstaging. A thorough evaluation of hilar and mediastinal LNs remains critical to ensure accurate staging by detection of occult LN metastases.
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17
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Zirafa CC, Romano G, Key TH, Davini F, Melfi F. The evolution of robotic thoracic surgery. Ann Cardiothorac Surg 2019; 8:210-217. [PMID: 31032204 DOI: 10.21037/acs.2019.03.03] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Robotic surgery has the features to represent the future of surgery, considering the rapid evolution of its technology and the resulting in the surgical field. In the last years, the robotic technique in thoracic surgery has progressively become widespread in the word, particularly for the treatment of the mediastinal and pulmonary lesions. The development of technology in the robotic system has been associated with the improvement of intraoperative and postoperative results. Due to the satisfying results and increasing experience and confidence with the robotic technique, surgeons are consequently enlarging the surgical indication, moving to increasingly challenging cases. Thoracic robotic surgery is being affirmed as a safe technique also for those complex cases, which in the past were considered a matter solely for open surgery. In fact, robotic surgery is increasingly associated with positive surgical results and guarantees less traumatism and a fast recovery to the patients. These positive results have resulted from the evolution of the technique, which has developed in parallel with the evolution of the technology, exploiting to its best the latest features of the robotic system. These features, such as the fluorescence-detection tool or the robotic stapler, have been aiding the surgeon to maximise the safety and feasibility of the application of the robotic technique to thoracic surgery.
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Affiliation(s)
- Carmelina C Zirafa
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Gaetano Romano
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Teresa Hung Key
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Federico Davini
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
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Long-term oncologic results for robotic major lung resection in non-small cell lung cancer (NSCLC) patients. Surg Oncol 2019; 28:223-227. [PMID: 30851905 DOI: 10.1016/j.suronc.2019.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/23/2019] [Accepted: 02/03/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE(S) Robotic lobectomy is becoming a widespread surgical procedure in NSCLC treatment, but data on oncologic outcomes is still lacking. The aim of this study was to analyze long term oncologic results of robotic lobectomy for non small lung cancer. METHODS Clinical records of consecutive NSCLC patients underwent robotic major surgery, between January 2010 and December 2015, were collected and analyzed. RESULTS We analyzed data of 212 patients (127 male and 85 female), with a median age of 66.3 years. The median follow-up time was 40.3 months (range 4-83). The median disease free survival was 66.3 months. Free disease survival stage-correlated was 75.6 months for stage I, 42.3 months for stage II, 51.2 months for stage III and 10.3 months for stage IV. The median overall survival was 78.6 months. Overall survival stage-correlated was 82 months for stage I, 73.5 months for stage II, 61.4 months for stage III and 41.3 months for stage IV. CONCLUSIONS This study suggests high safety level, positive post-operative and oncologic outcomes for patients NSCLC underwent robotic major surgery, also in advanced stages.
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Nodal upstaging evaluation in NSCLC patients treated by robotic lobectomy. Surg Endosc 2019; 33:153-158. [PMID: 29943062 DOI: 10.1007/s00464-018-6288-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Open pulmonary resection is considered the gold standard treatment of early-stage non-small cell lung cancer (NSCLC). However, in the last decades, the use of minimal-invasive techniques has given promising results. Survival in lung cancer, after surgery, depends on the number of pathological nodes (pN), thus lymph nodal upstaging can be considered a surrogate for surgical quality of the procedure. Several studies have demonstrated a lower rate of upstaging in video-assisted thoracic surgery than in open surgery, suggesting an approach-related difference in lymphadenectomy. Features of robotic technique could consent a lymph nodal dissection similar to open surgery. The aim of the study is to compare nodal upstaging between thoracotomy and robotic approaches to evaluate the oncologic radicality. METHODS Between January 2013 and December 2016, 212 consecutive cN0 NSCLC patients underwent lobectomy and lymphadenectomy (N1 + N2 stations) by either thoracotomy (Open Group) or robotic surgery (Robotic Group). RESULTS Lobectomy and lymphadenectomy were performed in 106 cN0-cN1 NSCLC patients by robotic surgery and in 106 cN0-cN1 NSCLC patients by open surgery. A mean of 14.42 ± 6.99 lymph nodes was removed in the Robotic Group (RG) and a mean of 14.32 ± 7.34 nodes in the Open Group (OG). Nodal upstaging was observed in 22 (20.75%) RG patients and in 19 OG (17.92%) patients. CONCLUSIONS Robotic lobectomy for clinical N0-N1 NSCLC appears to be equivalent to thoracotomy in terms of efficacy of lymph node dissection and nodal upstaging. Given that the nodal upstaging is a surrogate of quality of surgery, we can consider robotic lobectomy an appropriate procedure which ensures similar result to the open approach.
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Ismail M, Nachira D, Swierzy M, Ferretti GM, Englisch JP, Ossami Saidy RR, Li F, Badakhshi H, Rueckert JC. Lymph node upstaging for non-small cell lung cancer after uniportal video-assisted thoracoscopy. J Thorac Dis 2018; 10:S3648-S3654. [PMID: 30505548 DOI: 10.21037/jtd.2018.06.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Radical lymph node dissection (LND) plays a major role in the treatment of non-small cell lung cancer (NSCLC). This study presents the analysis of the results after uniportal video-assisted thoracoscopy (VATS) lymphadenectomy during anatomical lung resections for NSCLC, focusing on pathological nodal upstaging. Any possible risk factor affecting nodal upstaging was also investigated. Methods The prospectively collected clinical data of 136 patients undergone uniportal VATS anatomical lung resections, from June 2012 to September 2017, were reviewed. In particular, all details inherent the clinical and pathological node stage and any possible risk factor affecting nodal upstaging were analyzed. Results The patient population consisted of 90 males and 46 females; their mean age was 67.42±10.64 years. The mean number of lymph nodes retrieved during uniportal VATS lymphadenectomy was 20.14±10.73 (7.27±5.90 and 12.60±7.96 in N1 and N2 stations, respectively). The incidence of nodal upstaging was 13.3% (18 cases). In particular there was a N0-1 upstaging in 10 cases (7.4%), a N1-2 upstaging in 3 (2.2%) and a N0-2 in 4 (3%). The ROC analysis showed that the resection of 18 lymph nodes was the best predictor of a general upstaging with an AUC-ROC of 0.595, while the resection of 7 hilar lymph nodes was the best predictor of N1 upstaging (AUC-ROC: 0.554) and 11 mediastinal nodes was the best predictor of N2 upstaging (AUC-ROC: 0.671). The number of positive lymph nodes of stations 5-6 (OR: 2.035, 95% CI: 1.082-3.826, P=0.027) and stations 2-3-4 (OR: 6.198, 95% CI: 1.580-24.321, P=0.009) were confirmed to be the only independent risk factors for N2 upstaging by multivariate analysis. Conclusions According to our experience, uniportal VATS allows a safe and effective radical lymphadenectomy, with a satisfactory pathological nodal upstaging, comparable to other minimally invasive techniques.
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Affiliation(s)
- Mahmoud Ismail
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Marc Swierzy
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gian Maria Ferretti
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Julianna Paulina Englisch
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ramin Raul Ossami Saidy
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Feng Li
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Harun Badakhshi
- Department of Clinical Radiation Oncology, Ernst von Bergmann Medical Center, Potsdam, Germany
| | - Jens C Rueckert
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
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21
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Casiraghi M, Spaggiari L. Robotic resection of stage III lung cancer: an international retrospective study. J Thorac Dis 2018; 10:S3081-S3083. [PMID: 30370084 DOI: 10.21037/jtd.2018.07.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Monica Casiraghi
- Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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22
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Ricciardi S, Zirafa CC, Davini F, Melfi F. Robotic-assisted thoracic surgery versus uniportal video-assisted thoracic surgery: is it a draw? J Thorac Dis 2018; 10:1361-1363. [PMID: 29707285 DOI: 10.21037/jtd.2018.03.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sara Ricciardi
- Unit of Thoracic Surgery, Robotic Multispeciality Center for Surgery, University Hospital of Pisa, Pisa, Italy
| | - Carmelina Cristina Zirafa
- Unit of minimally invasive and robotic thoracic surgery, Robotic Multispeciality Center for Surgery, University Hospital of Pisa, Pisa, Italy
| | - Federico Davini
- Unit of minimally invasive and robotic thoracic surgery, Robotic Multispeciality Center for Surgery, University Hospital of Pisa, Pisa, Italy
| | - Franca Melfi
- Unit of minimally invasive and robotic thoracic surgery, Robotic Multispeciality Center for Surgery, University Hospital of Pisa, Pisa, Italy
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24
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Abstract
Lobectomy is still currently the gold standard for treatment of lung cancer. With the great advancement of robotic surgery, robotic lobectomy has been demonstrated to be an operation that is safe and can be done in a timely manner, similar to video-assisted thoracoscopic surgery (VATS). Additionally, reports show that long-term oncologic outcomes for robotic lobectomy are consistent with those reported for VATS and open lobectomy. Patients are selected in the same manner as those for VATS. Improved optics, increased dexterity of the instruments, and better ergonomics can yield subjective advantages to the surgeon. The techniques of port placement, mediastinal lymph node dissection and the steps of each of the five lobectomies are important and described in the chapter, for both the da Vinci Si and da Vinci Xi platforms. The subtle differences are highlighted. Additionally, advantages of the platforms are discussed.
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Affiliation(s)
- Paul Linsky
- Thoracic Surgery Resident, Division of Cardiothoracic Surgery
| | - Benjamin Wei
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham Medical Center, Birmingham, USA
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25
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Abstract
Robotic-assisted pulmonary lobectomy can be considered for patients fit for conventional lobectomy. Contraindications include prohibitive lung function or medical comorbidities, multistation N2, gross N2 disease, or evidence of N3 disease. Team training, familiarity with equipment, troubleshooting, and preparation are critical for successful robotic lobectomy. Similar to video-assisted thoracoscopic surgery (VATS) lobectomy, robotic lobectomy is associated with decreased blood loss, blood transfusion, air leak, chest tube duration, duration of stay, and mortality compared with thoracotomy. Robotic lobectomy offers many of the same benefits in perioperative morbidity and mortality, and the advantages of optics, dexterity, and surgeon ergonomics compared with VATS lobectomy.
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26
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Fugazzaro S, Costi S, Mainini C, Kopliku B, Rapicetta C, Piro R, Bardelli R, Rebelo PFS, Galeone C, Sgarbi G, Lococo F, Paci M, Ricchetti T, Cavuto S, Merlo DF, Tenconi S. PUREAIR protocol: randomized controlled trial of intensive pulmonary rehabilitation versus standard care in patients undergoing surgical resection for lung cancer. BMC Cancer 2017; 17:508. [PMID: 28760151 PMCID: PMC5537935 DOI: 10.1186/s12885-017-3479-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/10/2017] [Indexed: 02/08/2023] Open
Abstract
Background Non-small cell lung cancer is the most common type of lung cancer. Surgery is proven to be the most effective treatment in early stages, despite its potential impact on quality of life. Pulmonary rehabilitation, either before or after surgery, is associated with reduced morbidity related symptoms and improved exercise capacity, lung function and quality of life. Methods We describe the study protocol for the open-label randomized controlled trial we are conducting on patients affected by primary lung cancer (stages I-II) eligible for surgical treatment. The control group receives standard care consisting in one educational session before surgery and early inpatient postoperative physiotherapy. The treatment group receives, in addition to standard care, intensive rehabilitation involving 14 preoperative sessions (6 outpatient and 8 home-based) and 39 postoperative sessions (15 outpatient and 24 home-based) with aerobic, resistance and respiratory training, as well as scar massage and group bodyweight exercise training. Assessments are performed at baseline, the day before surgery and one month and six months after surgery. The main outcome is the long-term exercise capacity measured with the Six-Minute Walk Test; short-term exercise capacity, lung function, postoperative morbidity, length of hospital stay, quality of life (Short Form 12), mood disturbances (Hospital Anxiety and Depression Scale) and pain (Numeric Rating Scale) are also recorded and analysed. Patient compliance and treatment-related side effects are also collected. Statistical analyses will be performed according to the intention-to-treat approach. T-test for independent samples will be used for continuous variables after assessment of normality of distribution. Chi-square test will be used for categorical variables. Expecting a 10% dropout rate, assuming α of 5% and power of 80%, we planned to enrol 140 patients to demonstrate a statistically significant difference of 25 m at Six-Minute Walk Test. Discussion Pulmonary Resection and Intensive Rehabilitation study (PuReAIR) will contribute significantly in investigating the effects of perioperative rehabilitation on exercise capacity, symptoms, lung function and long-term outcomes in surgically treated lung cancer patients. This study protocol will facilitate interpretation of future results and wide application of evidence-based practice. Trial registration ClinicalTrials.gov Registry n. NCT02405273 [31.03.2015].
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Affiliation(s)
- Stefania Fugazzaro
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy. .,Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Via del Pozzo n°71, 41124, Modena, Italy. .,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, L.go P. Daneo n°3, 16132, Genoa, Italy.
| | - Carlotta Mainini
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Besa Kopliku
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Cristian Rapicetta
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Roberto Piro
- Pulmonology Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Roberta Bardelli
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Patricia Filipa Sobral Rebelo
- Physical Medicine and Rehabilitation Unit - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Carla Galeone
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Giorgio Sgarbi
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Filippo Lococo
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Massimiliano Paci
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Tommaso Ricchetti
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Silvio Cavuto
- Research and Statistics Infrastructure Unit, Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I n°50, 42123, Reggio Emilia, Italy
| | - Domenico Franco Merlo
- Research and Statistics Infrastructure Unit, Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I n°50, 42123, Reggio Emilia, Italy
| | - Sara Tenconi
- Unit of Thoracic Surgery - Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
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27
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Montané B, Toosi K, Velez-Cubian FO, Echavarria MF, Thau MR, Patel RA, Rodriguez K, Moodie CC, Garrett JR, Fontaine JP, Toloza EM. Effect of Obesity on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy. Surg Innov 2017; 24:122-132. [PMID: 28128014 DOI: 10.1177/1553350616687435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We investigated whether higher body mass index (BMI) affects perioperative and postoperative outcomes after robotic-assisted video-thoracoscopic pulmonary lobectomy. METHODS We retrospectively studied all patients who underwent robotic-assisted pulmonary lobectomy by one surgeon between September 2010 and January 2015. Patients were grouped according to the World Health Organization's definition of obesity, with "obese" being defined as BMI >30.0 kg/m2. Perioperative outcomes, including intraoperative estimated blood loss (EBL) and postoperative complication rates, were compared. RESULTS Over 53 months, 287 patients underwent robotic-assisted pulmonary lobectomy, with 7 patients categorized as "underweight," 94 patients categorized as "normal weight," 106 patients categorized as "overweight," and 80 patients categorized as "obese." Because of the relatively low sample size, "underweight" patients were excluded from this study, leaving a total cohort of 280 patients. There was no significant difference in intraoperative complication rates, conversion rates, perioperative outcomes, or postoperative complication rates among the 3 groups, except for lower risk of prolonged air leaks ≥7 days and higher risk of pneumonia in patients with obesity. CONCLUSIONS Patients with obesity do not have increased risk of intraoperative or postoperative complications, except for pneumonia, compared with "normal weight" and "overweight" patients. Robotic-assisted pulmonary lobectomy is safe and effective for patients with high BMI.
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Affiliation(s)
| | | | | | | | | | - Raj A Patel
- 1 University of South Florida, Tampa, FL, USA
| | | | | | | | - Jacques P Fontaine
- 1 University of South Florida, Tampa, FL, USA.,2 Moffitt Cancer Center, Tampa, FL, USA
| | - Eric M Toloza
- 1 University of South Florida, Tampa, FL, USA.,2 Moffitt Cancer Center, Tampa, FL, USA
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