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Moonsamy P, Schumacher L. Complete resection of left paratracheal nodes for stage IIIA disease can be achieved with robotics during left upper lobectomy after induction therapy. JTCVS Tech 2023; 22:285-289. [PMID: 38152219 PMCID: PMC10750465 DOI: 10.1016/j.xjtc.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Philicia Moonsamy
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass
| | - Lana Schumacher
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass
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Zirafa CC, Romano G, Sicolo E, Bagalà E, Manfredini B, Alì G, Castaldi A, Morganti R, Davini F, Fontanini G, Melfi F. Robotic versus Open Surgery in Locally Advanced Non-Small Cell Lung Cancer: Evaluation of Surgical and Oncological Outcomes. Curr Oncol 2023; 30:9104-9115. [PMID: 37887558 PMCID: PMC10605396 DOI: 10.3390/curroncol30100658] [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: 08/31/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
Locally advanced non-small cell lung cancer (NSCLC) consists of a heterogeneous group, with different pulmonary extension and lymph nodal involvement. Robotic surgery can play a key role in these tumours thanks to its technological features, although open surgery is still considered the gold-standard approach. Our study aims to evaluate the surgical and oncological outcomes of locally advanced NSCLC patients who underwent robotic surgery in a high-volume centre. Data from consecutive patients with locally advanced NSCLC who underwent robotic lobectomy were retrospectively analysed and compared with patients treated with open surgery. Clinical characteristics and surgical and oncological information were evaluated. From 2010 to 2020, 131 patients underwent anatomical lung resection for locally advanced NSCLC. A total of 61 patients were treated with robotic surgery (46.6%); the median hospitalization time was 5.9 days (range 2-27) and the postoperative complication rate was 18%. Open surgery was performed in 70 patients (53.4%); the median length of stay was 9 days (range 4-48) and the postoperative complication rate was 22.9%. The median follow-up time was 70 months. The 5-year overall survival was 34% in the robotic group and 31% in the thoracotomy group. Robotic surgery can be considered safe and feasible not only for early stages but also for the treatment of locally advanced NSCLC.
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Affiliation(s)
- Carmelina C. Zirafa
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (E.S.); (E.B.); (A.C.); (F.D.); (F.M.)
| | - Gaetano Romano
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (E.S.); (E.B.); (A.C.); (F.D.); (F.M.)
| | - Elisa Sicolo
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (E.S.); (E.B.); (A.C.); (F.D.); (F.M.)
| | - Elena Bagalà
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (E.S.); (E.B.); (A.C.); (F.D.); (F.M.)
| | - Beatrice Manfredini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Greta Alì
- Pathological Anatomy, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.A.); (G.F.)
| | - Andrea Castaldi
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (E.S.); (E.B.); (A.C.); (F.D.); (F.M.)
| | - Riccardo Morganti
- Section of Statistics, University Hospital of Pisa, 56124 Pisa, Italy;
| | - Federico Davini
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (E.S.); (E.B.); (A.C.); (F.D.); (F.M.)
| | - Gabriella Fontanini
- Pathological Anatomy, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.A.); (G.F.)
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (E.S.); (E.B.); (A.C.); (F.D.); (F.M.)
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3
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Zeng L, He T, Hu J. Minimally invasive thoracic surgery: robot-assisted versus video-assisted thoracoscopic surgery. Wideochir Inne Tech Maloinwazyjne 2023; 18:436-444. [PMID: 37868280 PMCID: PMC10585455 DOI: 10.5114/wiitm.2023.128714] [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: 12/28/2022] [Accepted: 04/12/2023] [Indexed: 10/24/2023] Open
Abstract
Minimally invasive techniques have been widely applied in general thoracic surgery. Compared with video-assisted thoracoscopic surgery (VATS), due to its theoretic superiority, robotic surgery is challenging the traditional position of VATS. With its unique advantages, including 3D vision and a high-freedom endowrist, it leads to easier lymph node dissection, more convenient blood vessel dissection, a shorter learning curve and competence for the completion of complex surgery. However, as a new surgical technology, the safety and efficacy of robotic-assisted thoracoscopic surgery (RATS) still need to be further verified. Thus, in this article, we review and summarize the application of RATS versus VATS in general thoracic surgery.
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Affiliation(s)
- Liping Zeng
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Tianyu He
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Shahin GMM, Vos PPWK, Hutteman M, Stigt JA, Braun J. Robot-assisted thoracic surgery for stages IIB-IVA non-small cell lung cancer: retrospective study of feasibility and outcome. J Robot Surg 2023:10.1007/s11701-023-01549-3. [PMID: 36928749 PMCID: PMC10374818 DOI: 10.1007/s11701-023-01549-3] [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: 10/04/2022] [Accepted: 02/23/2023] [Indexed: 03/18/2023]
Abstract
Robot-assisted thoracic surgery (RATS) for higher stages non-small cell lung carcinoma (NSCLC) remains controversial. This study reports the feasibility of RATS in patients with stages IIB-IVA NSCLC. A single-institute, retrospective study was conducted with patients undergoing RATS for stages IIB-IVA NSCLC, from January 2015 until January 2020. Unforeseen N2 disease was excluded. Data were collected from the Dutch Lung Cancer Audit database. Conversion rate, radical (R0) resection rate, local recurrence rate and complications were analyzed, as were risk factors for conversion. RATS was performed in 95 patients with NSCLC clinical or pathological stages IIB (N = 51), IIIA (N = 39), IIIB (N = 2) and IVA (N = 3). 10.5% had received neoadjuvant chemoradiotherapy. Pathological staging was T3 in 33.7% and T4 in 34.7%. RATS was completed in 77.9% with a radical resection rate of 94.8%. Lobectomy was performed in 67.4% of the total resections. Conversion was for strategic (18.9%) and emergency (3.2%) reasons. Pneumonectomy (p = 0.001), squamous cell carcinoma (p < 0.001), additional resection of adjacent structures (p = 0.025) and neoadjuvant chemoradiation (p = 0.017) were independent risk factors for conversion. Major post-operative complications occurred in ten patients (10.5%) including an in-hospital mortality of 2.1% (n = 2). Median recurrence-free survival was estimated at 39.4 months (CI 16.4-62.5). Two- and 5-year recurrence-free survival rates were 53.8% and 36.7%, respectively. This study concludes that RATS is safe and feasible in higher staged NSCLC tumors after exclusion of unforeseen N2 disease. It brings new perspective on the potential of RATS in higher stages, dealing with larger and more invasive tumors.
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Affiliation(s)
- Ghada M M Shahin
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Peter-Paul W K Vos
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Merlijn Hutteman
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos A Stigt
- Department of Pulmonology, Isala, Zwolle, The Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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5
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Shagabayeva L, Fu B, Panda N, Potter AL, Auchincloss HG, Mansur A, Jeffrey Yang CF, Schumacher L. Open, Video- and Robot-Assisted Thoracoscopic Lobectomy for Stage II-IIIA Non-Small Cell Lung Cancer. Ann Thorac Surg 2023; 115:184-190. [PMID: 35149049 DOI: 10.1016/j.athoracsur.2022.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/12/2021] [Accepted: 01/05/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study compares the short- and long-term outcomes of open vs robotic vs video-assisted thoracoscopic surgery (VATS) lobectomy for stage II-IIIA non-small-cell lung cancer (NSCLC). METHODS Outcomes of patients with stage II-IIIA NSCLC (excluding T4 tumors) who received open and minimally invasive surgery (MIS) lobectomy in the National Cancer Database from 2010 to 2017 were assessed using propensity score-matched analysis. RESULTS A propensity score-matched analysis of 4652 open and 4652 MIS patients demonstrated a decreased median length of stay associated with MIS compared with open lobectomy (5 vs 6 days; P < .001). There were no significant differences in 30-day mortality, 30-day readmission, or overall survival between the open and MIS groups. A propensity score-matched analysis of 1186 VATS and 1186 robotic patients showed that compared with VATS, the robotic approach was associated with no significant differences in 30-day mortality, 30-day readmission, and overall survival. However, the robotic group had a decreased median length of stay compared with VATS (4 vs 5 days; P < .001). The conversion rate was also significantly lower for robotic compared with VATS lobectomy (8.9% vs 15.9%, P < .001). CONCLUSIONS No significant differences were found in long-term survival between open and MIS lobectomy and between VATS and robotic lobectomy for stage II-IIIA NSCLC. However, the MIS approach was associated with a decreased length of stay compared with the open approach. The robotic approach was associated with decreased length of stay and decreased conversion rate compared with the VATS approach.
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Affiliation(s)
- Larisa Shagabayeva
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Beverly Fu
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Nikhil Panda
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexandra L Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Hugh G Auchincloss
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Arian Mansur
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; Wentworth Douglass Hospital, Dover, New Hampshire
| | - Lana Schumacher
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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Rocha Júnior E, Terra RM. Robotic lung resection: a narrative review of the current role on primary lung cancer treatment. J Thorac Dis 2022; 14:5039-5055. [PMID: 36647483 PMCID: PMC9840053 DOI: 10.21037/jtd-22-635] [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: 05/08/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022]
Abstract
Background and Objective Robotic-assisted thoracic surgery (RATS) has increasingly been applied to primary lung cancer treatment. Given the many facilities provided by the robotic platform in the manipulation of tissues and precision of movements, there is continuous enquiring about its contribution to the improvement of surgical outcomes. Also, the possibility to perform complex resections in a minimally invasive way using a robotic approach starts to become possible as the centers' learning curve expands. We propose to perform a review of the current status of robotic surgery for lung cancer focusing on key frontier points: sublobar resections, quality of lymphadenectomy, complex resections, postoperative outcomes, and innovative technologies to arrive. Methods We performed a narrative review of the literature aggregating the most current references available in English. Key Content and Findings According to the current data, the flourishing of the robotic platform seems to be in line with the spread of sublobar resections. The technological benefits inherent to the platform, also seem to promote an increase in the quality of lymphadenectomy and a shorter learning curve when compared to video-assisted thoracic surgery (VATS) with equivalent oncological results. Its application in complex resections such as bronchial sleeve already presents consistent results and new technology acquisitions such as three-dimensional reconstructions, augmented reality and artificial intelligence tend to be implemented collaborating with the digitization of surgery. Conclusions Robotic surgery for lung cancer resection is at least equivalent to the VATS approach considering the currently available literature. However, more practice time and prospective clinical trials are needed to identify more exact benefits.
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Affiliation(s)
- Eserval Rocha Júnior
- Division of Thoracic Surgery at University of São Paulo (USP), Instituto do Câncer do Estado de São Paulo (ICESP) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil;,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Ricardo Mingarini Terra
- Division of Thoracic Surgery at University of São Paulo (USP), Instituto do Câncer do Estado de São Paulo (ICESP) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil;,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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7
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Galetta D, De Marinis F, Spaggiari L. Rescue Surgery after Immunotherapy/Tyrosine Kinase Inhibitors for Initially Unresectable Lung Cancer. Cancers (Basel) 2022; 14:cancers14112661. [PMID: 35681639 PMCID: PMC9179896 DOI: 10.3390/cancers14112661] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Locally advanced or metastatic non-small cell lung cancer (NSCLC) has been considered for a long time as an unresectable disease. Chemotherapy was considered the only therapeutic option for these conditions and the results were unsatisfactory. Recent advances in biology and immunology have led to the use of personalized treatments by using tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs), which produce significant and durable treatment responses. Large trials explored the utility of TKIs and ICIs in neoadjuvant or adjuvant settings, showing good results in terms of radiological response and long-term outcomes. Retrospective case series in patients with the previously unresectable disease who received treatment with TKIs, or ICIs showed important clinical changes that consider the possibility of pulmonary resection of the residual disease. They showed an overall feasibility for pulmonary resection but also raised concerns about the technical challenges. In the present study, we analyzed and reported the surgical and long-term outcomes of patients with initial unresectable, locally advanced, or oligometastatic NSCLC who were treated with TKIs or ICIs achieving a clinical downstaging so as to re-enter resectability. Abstract Background: We report the outcomes for unresectable patients with locally advanced or oligometastatic non-small cell lung cancer (NSCLC) treated with tyrosine kinase inhibitor (TKI) or immunotherapy who achieved a clinical downstaging so as to re-enter resectability. Methods: We retrospectively reviewed the clinical, surgical, and pathological data of 42 patients with histologically proven, inoperable NSCLC who received rescue surgery after a good response to TKI or immunotherapy between March 2014 and December 2021. Results: Of 42 patients, 39 underwent pulmonary resection with therapeutic intent (three explorative thoracotomies). There were 26 males, with a median age of 64 years (range, 41–78 years). Twenty-three patients received TKIs and 19 immunotherapies. Anatomic resection was performed in 97.4% of resected patients (38/39) including 30 lobectomies, one right upper sleeve lobectomy, five pneumonectomies, one tracheal sleeve pneumonectomy, and one bilobectomy; a patient underwent wedge resection. Of 10 procedures attempted via a robotic approach, two required conversion to thoracotomy. No intraoperative morbidity/mortality occurred. The median operative time was 190 (range, 80–426) minutes; estimated blood loss was 200 mL (range, 35–780 mL). Morbidity occurred in 13/39 (33.3%). The median length of hospital stay was 6.5 days (range, 4–23 days). Pathologic downstaging was 74.4% (29/39). With a median follow-up of 28.7 months, the 5-year disease-free interval was 46.5%, and the 5-year overall survival was 66.0%; 32/39 patients (82.1%) are alive, 10 with the disease. Conclusions: Lung resection for suspected residual disease after immunotherapy or TKIs is feasible, with encouraging pathological downstaging. Surgical operation may be technically challenging due to the presence of fibrosis, but significant morbidity appears to be rare. Outcomes are encouraging, with reasonable survival during the short-interval follow-up.
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Affiliation(s)
- Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy;
- Department of Oncology and Hematology-Oncology-DIPO, University of Milan, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-0257489801
| | - Filippo De Marinis
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy;
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy;
- Department of Oncology and Hematology-Oncology-DIPO, University of Milan, 20122 Milan, Italy
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Huang J, Tian Y, Li C, Shen Y, Li H, Lv F, Lin H, Lu P, Lin J, Lau C, Terra RM, Jiang L, Luo Q. Robotic-assisted thoracic surgery reduces perioperative complications and achieves a similar long-term survival profile as posterolateral thoracotomy in clinical N2 stage non-small cell lung cancer patients: a multicenter, randomized, controlled trial. Transl Lung Cancer Res 2022; 10:4281-4292. [PMID: 35004256 PMCID: PMC8674609 DOI: 10.21037/tlcr-21-898] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/24/2021] [Indexed: 12/25/2022]
Abstract
Background Our previous study demonstrated the safety and short-term efficacy of robotic-assisted thoracic surgery (RATS) in clinical N2 (c-N2) stage non-small cell lung cancer (NSCLC) patients. From this, the present study was devised, in which the follow-up time and sample size were both extended to explore the long-term efficacy and potential benefit in survival of RATS compared with lobectomy in c-N2 stage NSCLC patients. Methods Patients with c-N2 NSCLS were randomly assigned in a 1:1 ratio to accept operation through thoracotomy or RATS. The da Vinci Surgical System (Si/Xi) was applied in the RATS group, while conventional lobectomy with a rib-spreading incision was applied in the posterolateral thoracotomy group. Primary endpoint was defined as disease free survival and overall survival (OS) of all recruited patients. Results Compared with posterolateral thoracotomy group (N=72), the RATS group (N=76) had a reduced blood loss (P<0.001), decreased drainage duration (P=0.002), and decreased postoperative pain visual analog score (all P<0.001), but increased overall cost (P<0.001). Meanwhile, no difference in the other postoperative complications (such as air leakage, subcutaneous emphysema, atrial fibrillation etc.) was found between the RATS group and the posterolateral thoracotomy group (all P>0.05). Regarding long-term outcome, no difference in disease-free survival (DFS; P=0.925) or OS (P=0.853) was observed between the RATS group and posterolateral thoracotomy group. Subgroup analyses and multivariable Cox regression analyses also found no difference in DFS or OS between the RATS group and posterolateral thoracotomy groups. Conclusions RATS reduced intraoperative bleeding, drainage duration, postoperative pain, and achieved similar long-term survival outcomes compared with posterolateral thoracotomy in c-N2 stage NSCLC patients. Trial registration Chinese Clinical Trial Registry ChiCTR-INR-17012777.
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Affiliation(s)
- Jia Huang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Tian
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chongwu Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yaofeng Shen
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fanzhen Lv
- Department of Thoracic Surgery, The Affiliated Huadong Hospital of Fudan University, Shanghai, China
| | - Hao Lin
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Peiji Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jules Lin
- Department of Surgery, Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Ricardo Mingarini Terra
- Thoracic Surgery Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Long Jiang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qingquan Luo
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Park BJ. Minimally invasive lung resection after induction therapy: Is there evidence? JTCVS OPEN 2021; 8:585-587. [PMID: 36004063 PMCID: PMC9390738 DOI: 10.1016/j.xjon.2021.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/08/2021] [Indexed: 11/26/2022]
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10
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Cao C, Le A, Bott M, Yang CFJ, Gossot D, Melfi F, Tian DH, Guo A. Meta-Analysis of Neoadjuvant Immunotherapy for Patients with Resectable Non-Small Cell Lung Cancer. Curr Oncol 2021; 28:4686-4701. [PMID: 34898553 PMCID: PMC8628782 DOI: 10.3390/curroncol28060395] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/22/2021] [Accepted: 11/10/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Immunotherapy has created a paradigm shift in the treatment of metastatic non-small cell lung cancer (NSCLC), overcoming the therapeutic plateau previously achieved by systemic chemotherapy. There is growing interest in the utility of immunotherapy for patients with resectable NSCLC in the neoadjuvant setting. The present systematic review and meta-analysis aim to provide an overview of the existing evidence, with a focus on pathological and radiological response, perioperative clinical outcomes, and long-term survival. METHODS A systematic review was conducted using electronic databases from their dates of inception to August 2021. Pooled data on pathological response, radiological response, and perioperative outcomes were meta-analyzed where possible. RESULTS Eighteen publications from sixteen studies were identified, involving 548 enrolled patients who underwent neoadjuvant immunotherapy, of whom 507 underwent surgery. Pathologically, 52% achieved a major pathological response, 24% a complete pathological response, and 20% reported a complete pathological response of both the primary lesion as well as the sampled lymph nodes. Radiologically, 84% of patients had stable disease or partial response. Mortality within 30 days was 0.6%, and morbidities were reported according to grade and frequency. CONCLUSION The present meta-analysis demonstrated that neoadjuvant immunotherapy was feasible and safe based on perioperative clinical data and completion rates of surgery within their intended timeframe. The pathological response after neoadjuvant immunotherapy was superior to historical data for patients who were treated with neoadjuvant chemotherapy alone, whilst surgical and treatment-related adverse events were comparable. The limitations of the study included the heterogenous treatment regimens, lack of long-term follow-up, variations in the reporting of potential prognostic factors, and potential publication bias.
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Affiliation(s)
- Christopher Cao
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney University, Sydney, NSW 2050, Australia; (A.L.); (A.G.)
- Chris O’Brien Lifehouse Hospital, Sydney, NSW 2050, Australia
| | - Anthony Le
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney University, Sydney, NSW 2050, Australia; (A.L.); (A.G.)
| | - Matthew Bott
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Dominique Gossot
- Department of Thoracic Surgery, Institut du Thorax Curie-Montsouris, 75014 Paris, France;
| | - Franca Melfi
- Robotic Multispecialty Center for Surgery Robotic, Minimally Invasive Thoracic Surgery, University of Pisa, 56124 Pisa, Italy;
| | - David H. Tian
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, NSW 2145, Australia;
| | - Allen Guo
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney University, Sydney, NSW 2050, Australia; (A.L.); (A.G.)
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Preliminary Results of Robotic Lobectomy in Stage IIIA-N2 NSCLC after Induction Treatment: A Case Control Study. J Clin Med 2021; 10:jcm10163465. [PMID: 34441761 PMCID: PMC8396941 DOI: 10.3390/jcm10163465] [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] [Received: 06/04/2021] [Revised: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 11/16/2022] Open
Abstract
Despite there already being many studies on robotic surgery as a minimally invasive approach for non-small-cell lung cancer (NSCLC) patients, the use of this technique for stage III disease is still poorly described. These are the preliminary results of our prospective study on the safety and effectiveness of robotic approaches in patients with locally advanced NSCLC in terms of postoperative complications and oncological outcomes. Since 2016, we prospectively investigated 19 consecutive patients with NSCLC stage IIIA-pN2 (diagnosed by EBUS-TBNA) who underwent lobectomy and radical lymph node dissection with robotic approaches after induction treatment. Furthermore, we matched a case-control study with 46 patients treated with open surgery during the same period of time, with similar age, comorbidities, clinical stage and tumor size. The individual matched population was composed of 16 robot-assisted thoracic surgeries and 16 patients who underwent open surgery. The median time range of resection was inferior in the open group compared to robotic lobectomy (243 vs. 161 min; p < 0.001). Lymph node resection and positivity were not significantly different (p = 0.96 and p = 0.57, respectively). Moreover, no difference was observed for PFS (p = 0.16) or OS (p = 0.41). In conclusion, we demonstrated that the early outcomes and oncological results of N2-patients after robotic lobectomy were similar to those who had open surgery. Considering the advantages of minimally invasive surgery, robot-assisted lobectomy appears to be a safe approach to patients with locally advanced diseases.
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12
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Tong BC, Gu L, Wang X, Wigle DA, Phillips JD, Harpole DH, Klapper JA, Sporn T, Ready NE, D'Amico TA. Perioperative outcomes of pulmonary resection after neoadjuvant pembrolizumab in patients with non-small cell lung cancer. J Thorac Cardiovasc Surg 2021; 163:427-436. [PMID: 33985811 DOI: 10.1016/j.jtcvs.2021.02.099] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Pembrolizumab is a programmed death receptor-1 masking antibody approved for metastatic non-small cell lung cancer. This Phase 2 study (NCT02818920) of neoadjuvant pembrolizumab in non-small cell lung cancer had a primary end point of safety and secondary end points of efficacy and correlative science. METHODS Patients with untreated clinical stage IB to IIIA non-small cell lung cancer were enrolled. Two cycles of pembrolizumab (200 mg) were administered before surgery. Standard adjuvant chemotherapy and radiation were encouraged but not required. Four cycles of adjuvant pembrolizumab were provided. RESULTS Of 35 patients enrolled, 30 received neoadjuvant pembrolizumab and 25 underwent lung resection. Only 1 patient had a delay before surgery attributed to pembrolizumab; this was due to thyroiditis. All patients underwent anatomic resection and mediastinal lymph node dissection; the majority (18/25%, 72%) of patients underwent lobectomy. Of the 25 patients, 23 had an initial minimally invasive approach (92%); 5 of these were converted to thoracotomy (21.7%). R0 resection was achieved in 22 patients (88%), and major pathologic response was observed in 7 of 25 patients (28%). The most common postoperative adverse event was atrial fibrillation, affecting 6 of 25 patients (24%). Median chest tube duration and length of stay were 3 and 4 days, respectively. One patient required readmission to the hospital within 30 days. There was no mortality within 90 days of surgery. CONCLUSIONS In this study, pembrolizumab was safe and well tolerated in the neoadjuvant setting, and its use was not associated with excess surgical morbidity or mortality. Minimally invasive approaches are feasible in this patient population, but may be more challenging than in cases without neoadjuvant immunotherapy. Pathologic response was higher than typically observed with standard neoadjuvant chemotherapy.
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Affiliation(s)
- Betty C Tong
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC.
| | - Lin Gu
- Duke Cancer Institute Biostatistics Shared Resource, Duke University School of Medicine, Durham, NC
| | - Xiaofei Wang
- Duke Cancer Institute Biostatistics Shared Resource, Duke University School of Medicine, Durham, NC
| | - Dennis A Wigle
- Department of Thoracic Surgery, Mayo Clinic, Rochester, Minn
| | - Joseph D Phillips
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David H Harpole
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Jacob A Klapper
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Thomas Sporn
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Neal E Ready
- Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Thomas A D'Amico
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
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13
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Scheinerman JA, Jiang J, Chang SH, Geraci TC, Cerfolio RJ. Extended Robotic Pulmonary Resections. Front Surg 2021; 8:597416. [PMID: 33693026 PMCID: PMC7937914 DOI: 10.3389/fsurg.2021.597416] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/05/2021] [Indexed: 11/13/2022] Open
Abstract
While lung cancer remains the most common cause of cancer-related mortality in the United States, surgery for curative intent continues to be a mainstay of therapy. The robotic platform for pulmonary resection for non-small cell lung cancer (NSCLC) has been utilized for more than a decade now. With respect to more localized resections, such as wedge resection or lobectomy, considerable data exist demonstrating shorter length of stay, decreased postoperative pain, improved lymph node dissection, and overall lower complication rate. There are a multitude of technical advantages the robotic approach offers, such as improved optics, natural movement of the operator's hands to control the instruments, and precise identification of tissue planes leading to a more ergonomic and safe dissection. Due to the advantages, the scope of robotic resections is expanding. In this review, we will look at the existing data on extended robotic pulmonary resections, specifically post-induction therapy resection, sleeve lobectomy, and pneumonectomy. Additionally, this review will examine the indications for these more complex resections, as well as review the data and outcomes from other institutions' experience with performing them. Lastly, we will share the strategy and outlook of our own institution with respect to these three types of extended pulmonary resections. Though some controversy remains regarding the use and safety of robotic surgery in these complex pulmonary resections, we hope to shed some light on the existing evidence and evaluate the efficacy and safety for patients with NSCLC.
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Affiliation(s)
- Joshua A Scheinerman
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Jeffrey Jiang
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
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14
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Abstract
Locally advanced lung cancer, defined by nodal involvement in upper mediastinal stations (N2) (stage IIIA–N2), includes a wide spectrum of patients with multiple therapeutic alternatives. Such heterogeneity is explained, at least in part, by tumor size and magnitude of mediastinal nodal involvement. In this setting, many variants can influence the prognosis, such as the specific nodal stations compromised, the burden of mediastinal disease, and the presence of skip metastasis. In the surgical field, the advent of minimally invasive techniques, including video-assisted thoracoscopic and robotic surgery, have revolutionized the management of early-stage lung cancer, but implementations of these approaches in the locally advanced setting have been erratic. This review attempts to highlight the most relevant scientific data of the surgical management of locally advanced lung cancer patients, analyzing not only the medical evidence but also the cost-effectiveness and accessibility.
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Affiliation(s)
- Ana Karina Patané
- Department of Thoracic Surgery, Hospital de Rehabilitación Respiratoria María Ferrer, Buenos Aires, Argentina
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15
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Weder W, Furrer K, Opitz I. Robotic-assisted thoracoscopic surgery for clinically stage IIIA (c-N2) NSCLC-is it justified? Transl Lung Cancer Res 2021; 10:1-4. [PMID: 33569286 PMCID: PMC7867792 DOI: 10.21037/tlcr-20-647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Walter Weder
- Thoracic Surgery, Klinik Bethanien, Zürich, Switzerland
| | - Katarzyna Furrer
- Department of Thoracic Surgery, University Hospital Zurich, Zürich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zürich, Switzerland
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16
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Herb JN, Kindell DG, Strassle PD, Stitzenberg KB, Haithcock BE, Mody GN, Long JM. Trends and Outcomes in Minimally Invasive Surgery for Locally Advanced Non-Small-Cell Lung Cancer With N2 Disease. Semin Thorac Cardiovasc Surg 2020; 33:547-555. [PMID: 32979480 PMCID: PMC10715223 DOI: 10.1053/j.semtcvs.2020.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/08/2020] [Indexed: 11/11/2022]
Abstract
Few studies examine outcomes by surgical approach in non-small-cell lung cancer (NSCLC) with N2 disease. We examined time trends in surgical approach and outcomes among patients undergoing minimally invasive (MIS, robotic and video-assisted thoracoscopic surgery [VATS]) vs open lobectomy in this patient population. We performed a retrospective analysis of patients from the National Cancer Database diagnosed with clinical Stage IIIA-N2 NSCLC from 2010 to 2016. We examined the yearly proportion of MIS vs open resections. Multivariable regression was used to assess the association of surgical approach with length of stay, unplanned readmissions, 30-day and 90-day mortality. Multivariable Cox proportional hazards modeling was used to assess the association of surgical approach with 5-year overall mortality. We identified 5741 patients who underwent lobectomy for Stage IIIA-N2 NSCLC (459 robotic, 1403 VATS, 3879 open). From 2010 to 2016, the proportion of minimally invasive procedures increased from 20% to 45%. MIS patients, on average, stayed 1 day less in the hospital (95% confidence interval [CI] 0.7, 1.5) and had lower odds of 90-day (odds ratio [OR] 0.74; 95% CI 0.54, 0.99) and 5-year mortality (OR 0.82; 95% CI 0.75, 0.91), compared to open resections. There was no difference in odds of readmission by surgical approach (OR 0.97; 95% CI 0.71, 1.33). Among MIS procedures, robotic resections had lower odds of 90-day mortality (OR 0.42; 95% CI 0.18, 0.97) than VATS. Among patients undergoing lobectomy for locally advanced N2 NSCLC robotic and VATS techniques appear safe and effective compared to open surgery and may offer short- and long-term advantages.
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Affiliation(s)
- Joshua N Herb
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Daniel G Kindell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Paula D Strassle
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karyn B Stitzenberg
- Division of Surgical Oncology, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Benjamin E Haithcock
- Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gita N Mody
- Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jason M Long
- Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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17
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Evaluation of a Powered Vascular Stapler in Video-Assisted Thoracic Surgery Lobectomy. J Surg Res 2020; 253:26-33. [DOI: 10.1016/j.jss.2020.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/24/2020] [Accepted: 03/09/2020] [Indexed: 11/22/2022]
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18
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Zeltsman M, Dozier J, Vaghjiani RG, Poch A, Eguchi T, Pedoto A, Jones DR, Adusumilli PS. Decreasing use of epidural analgesia with increasing minimally invasive lobectomy: Impact on postoperative morbidity. Lung Cancer 2020; 139:68-72. [PMID: 31743888 PMCID: PMC7171549 DOI: 10.1016/j.lungcan.2019.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/17/2019] [Accepted: 11/01/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The goal of this study is to investigate the use of EA and its impact on the postoperative short-term outcomes of patients with non-small cell lung cancer (NSCLC) who received a lobectomy by either minimally invasive surgery (MIS) or thoracotomy. MATERIALS AND METHODS We investigated 793 patients who underwent lobectomy for pathological stage I-III NSCLC without induction therapy during two time periods, an early-time period (2009-2010: MIS, n = 204 [53%]; and thoracotomy, n = 182 [47%]) and a late-period (2014-2015: MIS, n = 308 [76%]; and thoracotomy, n = 99 [24%]). Patient characteristics, including pulmonary function tests, comorbidities, and use of EA, as well as short-term outcomes, including length of stay, morbidity, and mortality were assessed and compared between early-and late-time periods. We also compared patients who received EA (n = 150) with patients who did not receive EA (n = 158) following MIS lobectomy in the late-time period. RESULTS The use of MIS lobectomy increased during the late-time period compared to the early-time period (p < 0.001). In patients who underwent MIS lobectomy, the use of EA significantly decreased in the late-time period compared to the early-time period (2009-2010 vs. 2014-2015, 95% vs. 51%; p < 0.001). There was no difference in postoperative morbidity and mortality between the two time periods in both MIS and thoracotomy. In the late-time period MIS group, the length of stay in the no EA group (n = 150) was shorter than that in the EA group (n = 158) (3 vs. 4 days, p = 0.038). There was no difference in morbidity and mortality between the EA and no EA groups. CONCLUSION In our study cohort, the observed decrease in the use of EA with the increasing rate of MIS lobectomy did not negatively affect postoperative short-term outcomes.
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Affiliation(s)
- Masha Zeltsman
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Jordan Dozier
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Raj G Vaghjiani
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Alexandra Poch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Takashi Eguchi
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Alessia Pedoto
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA; Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA.
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19
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Li C, Hu Y, Huang J, Li J, Jiang L, Lin H, Lu P, Luo Q. Comparison of robotic-assisted lobectomy with video-assisted thoracic surgery for stage IIB-IIIA non-small cell lung cancer. Transl Lung Cancer Res 2019; 8:820-828. [PMID: 32010560 DOI: 10.21037/tlcr.2019.10.15] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background With the rapid development of surgical technics and instruments, more and more locally advanced non-small cell lung cancer (NSCLC) patients are being treated by minimally invasive surgery (MIS), including video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS). The aim of this retrospective study was to compare the perioperative and long-term outcomes of patients who underwent lobectomy by these two surgical approaches. Methods We performed a retrospective review of the prospectively collected database of our hospital to identify patients with clinical stage IIB-IIIA NSCLC who underwent video-assisted thoracoscopic or robotic lobectomy. Perioperative outcomes, recurrence, and overall survival (OS) were compared. Results From January 2014 to January 2017, there were at total of 121 patients, including 36 robotic lobectomy patients and 85 VATS lobectomy patients. One patient (2.8%) in the RATS group and 5 patients (5.9%) in the VATS group were converted to thoracotomy (P=0.79). No perioperative death was observed in both groups. The postoperative morbidity was similar between the two groups (13.9% for RATS vs. 15.3% for VATS; P=0.84). Robotic lobectomy was associated with a shorter length of postoperative hospital stay (4 vs. 5 d, P<0.01) and more counts of lymph nodes harvested (13 vs. 10, P<0.01). The median disease-free survival (DFS) for the RATS and VATS groups were 31.1 and 33.8 months, respectively. The corresponding 3-year DFS was 40.3% in the RATS group and 47.6% in the VATS group (P=0.74). The 3-year OS was 75.7% in RATS and 77.0% in the VATS group (P=0.75). Conclusions For selected NSCLC patients with lymph node involvement, robotic lobectomy is safe and effective with a low complication rate and similar long-term outcome compared with VATS lobectomy. Moreover, the robotic approach resulted in shorter postoperative length of stay and greater lymph node assessment.
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Affiliation(s)
- Chongwu Li
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
| | - Yingjie Hu
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
| | - Jia Huang
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
| | - Jiantao Li
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
| | - Long Jiang
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
| | - Hao Lin
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
| | - Peiji Lu
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
| | - Qingquan Luo
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
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20
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Huang J, Li C, Li H, Lv F, Jiang L, Lin H, Lu P, Luo Q, Xu W. Robot-assisted thoracoscopic surgery versus thoracotomy for c-N2 stage NSCLC: short-term outcomes of a randomized trial. Transl Lung Cancer Res 2019; 8:951-958. [PMID: 32010573 DOI: 10.21037/tlcr.2019.11.31] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Safety and short-term efficacy of robot-assisted thoracoscopic surgery (RATS) for early-stage non-small cell lung cancer (NSCLC) have been previously proven; however, RATS for N2 stage NSCLC was barely evaluated. The aim of this randomized controlled trial (RCT) was to explore the short-term outcome of RATS for cN2 stage NSCLC. Methods Total of 113 patients who were diagnosed with clinically single cN2 stage NSCLC were enrolled and randomly assigned to RATS and thoracotomy groups. The patients in RATS group were treated by lobectomy and mediastinal lymph node dissection using the da Vinci Surgical System, while the patients in thoracotomy group underwent lobectomy and mediastinal lymph node dissection from. And, short-term outcomes were analyzed statistically. Results The data from 108 subjects (58 in RATS and 55 in thoracotomy groups) were eligible for analyses. Five patients who received robot-assisted lobectomy initially was converted intraoperatively to open operation due to extensive pleural adhesion and equipment issues. And, one subject underwent robot-assisted surgery was died preoperatively due to pulmonary embolism. Compared with thoracotomy, RATS was associated with less intraoperative blood loss (86.3±41.1 vs. 165.7±46.4 mL, P<0.001), median chest duration (4 vs. 5, P<0.01), visual analog scores at postoperative day one to five (P<0.001), and slightly fewer incidence of postoperative complications. Also, both surgical approaches revealed comparable drainages and nodal harvest. The cancer residual margins occurred in one subject in RATS group and three patients in thoracotomy group (P=0.56). However, overall cost of subjects underwent RATS was higher than those received thoracotomy (100,367±19,251 vs. 82,002±20,434, P<0.001). Conclusions Present study proves that the feasibility and safety of RATS lobectomy to treat patients with cN2 stage NSCLC, and it should be superior to thoracotomy due to lesser intraoperative blood loss.
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Affiliation(s)
- Jia Huang
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang xxxx, China
| | - Chongwu Li
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai xxxx, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai xxxx, China
| | - Fanzhen Lv
- Department of Thoracic Surgery, The Affiliated Huadong Hospital of Fudan University, Shanghai xxxx, China
| | - Long Jiang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai xxxx, China
| | - Hao Lin
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai xxxx, China
| | - Peiji Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai xxxx, China
| | - Qingquan Luo
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai xxxx, China
| | - Wenrong Xu
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang xxxx, China
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21
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Veronesi G, Novellis P, Voulaz E, Bruschini P. Robotic assisted lung resection for locally advanced lung cancer. Expert Rev Respir Med 2019; 14:121-124. [PMID: 31779503 DOI: 10.1080/17476348.2020.1697235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Giulia Veronesi
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Pierluigi Novellis
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Emanuele Voulaz
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Pietro Bruschini
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
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22
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Lin J. Robotic-assisted lobectomy for locally advanced N2 non-small cell lung cancer. J Thorac Dis 2019; 11:3220-3224. [PMID: 31559023 DOI: 10.21037/jtd.2019.08.23] [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)
- Jules Lin
- Department of Surgery, Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
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23
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Veronesi G, Park B, Cerfolio R, Dylewski M, Toker A, Fontaine JP, Hanna WC, Morenghi E, Novellis P, Velez-Cubian FO, Amaral MH, Dieci E, Alloisio M, Toloza EM. Robotic resection of Stage III lung cancer: an international retrospective study. Eur J Cardiothorac Surg 2019; 54:912-919. [PMID: 29718155 DOI: 10.1093/ejcts/ezy166] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/25/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Minimally invasive surgery is accepted for early-stage lung cancer, but its role in locally advanced disease is controversial, especially using a robotic platform. The aim of this retrospective study was to assess the safety and effectiveness of robot-assisted resection in patients with Stage IIIA non-small-cell lung cancer (NSCLC) or carcinoid tumours in the series as a whole and in different subgroups according to adjuvant treatment. METHODS This was a retrospective multicentre study of consecutive patients with clinically evident or occult N2 disease (210 NSCLC and 13 carcinoid) who, in 2007-2016, underwent robot-assisted resection at 7 high-volume centres. Perioperative outcomes, recurrences and overall survival were assessed. RESULTS N2 disease was diagnosed preoperatively in 72 (32%) patients and intraoperatively in 151 (68%) patients. Surgical margins were negative in 98.4% of cases with available data. Thirty-four (15.2%) patients received neoadjuvant treatment, 140 (63%) patients received postoperative treatment, and 49 (22%) patients underwent surgery only. There were 22 (9.9%) conversions to thoracotomy, 23 (10.3%) had serious (Grades III-IV) postoperative morbidity and the mean hospital stay was 5.3 days. Complications and outcomes did not differ significantly between treatment groups. Of the 34 patients who were given neoadjuvant chemotherapy, all had R0 resection, 5 (15%) patients required conversion but none required conversion because of bleeding and 4 (12%) patients had Grade III or IV postoperative complications. After a median of 18 (interquartile range 8-33) months, 3-year overall survival in NSCLC patients was 61.2% and 60.3% (P = 0.6) of patients in the subgroup were given induction treatment. However, overall survival was significantly better (P = 0.012) in NSCLC patients with ≤2 positive nodes (vs >2). Nineteen (8.5%) patients developed local recurrence. CONCLUSIONS Robot-assisted lobectomy is safe and effective in patients with Stage III NSCLC or carcinoid tumours with low conversions and complications. Among patients with NSCLC, including those who were given induction chemotherapy, survival was similar to that reported for open surgery.
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Affiliation(s)
- Giulia Veronesi
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Bernard Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert Cerfolio
- Thoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark Dylewski
- Department of Cardiothoracic Surgery, Baptist Health South Florida-South Miami Hospital, South Miami, FL, USA
| | - Alpert Toker
- Department of Thoracic Surgery, Group Florence Nightingale Hospitals, Istanbul, Turkey
| | - Jacques P Fontaine
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Surgery, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA
| | - Wael C Hanna
- Department of Surgery, Division of Thoracic Surgery, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
| | - Pierluigi Novellis
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Frank O Velez-Cubian
- Department of Surgery, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA
| | - Marisa H Amaral
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Elisa Dieci
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
| | - Eric M Toloza
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Surgery, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA
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24
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Affiliation(s)
- Gregor J Kocher
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
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25
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Cheng X, Li C, Huang J, Lu P, Luo Q. Three-arm robot-assisted thoracoscopic surgery for locally advanced N2 non-small cell lung cancer. J Thorac Dis 2019; 10:7009-7013. [PMID: 30746247 DOI: 10.21037/jtd.2018.11.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Xinghua Cheng
- Shanghai Chest Hospital, Shanghai Pulmonary Tumor Medical Center, Shanghai 200030, China
| | - Chongwu Li
- Shanghai Chest Hospital, Shanghai Pulmonary Tumor Medical Center, Shanghai 200030, China
| | - Jia Huang
- Shanghai Chest Hospital, Shanghai Pulmonary Tumor Medical Center, Shanghai 200030, China
| | - Peiji Lu
- Shanghai Chest Hospital, Shanghai Pulmonary Tumor Medical Center, Shanghai 200030, China
| | - Qingquan Luo
- Shanghai Chest Hospital, Shanghai Pulmonary Tumor Medical Center, Shanghai 200030, China
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Tian Z, Sui X, Yang F, Wang J. Is video-assisted thoracoscopy a sufficient approach for mediastinal lymph node dissection to treat lung cancer after neoadjuvant therapy? Thorac Cancer 2019; 10:782-790. [PMID: 30756507 PMCID: PMC6449226 DOI: 10.1111/1759-7714.12999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/12/2019] [Accepted: 01/13/2019] [Indexed: 12/01/2022] Open
Abstract
Background The role of video‐assisted thoracoscopic surgery (VATS) in mediastinal lymph node dissection (MLND) for non‐small cell lung cancer (NSCLC) following neoadjuvant therapy remains controversial. The aim of this study was to demonstrate the sufficiency of VATS by evaluating perioperative and long‐term outcomes. Methods Patients with locally advanced NSCLC and treated with radical surgery after neoadjuvant therapy were identified in our database. The thoroughness of MLND was compared by approach. Multivariable logistic regression analysis was used to evaluate predictors of sufficient MLND. Propensity score matching was performed. Kaplan–Meier and Cox proportional hazard analyses were used to assess long‐term survival. Results Of the 127 enrolled patients, 56 underwent attempted VATS and 71 underwent thoracotomy. Multivariable logistic regression analysis revealed that approach was not a predictor of sufficient MLND (odds ratio 0.81, 95% confidence interval [CI] 0.364–1.803; P = 0.606). After matching, 28 pairs of patients were selected from the two groups. There was no significant difference between the numbers of dissected lymph nodes (15 vs. 20; P = 0.191) and nodal stations (7 vs. 7; P = 0.315). Recurrence‐free (log‐rank P = 0.613) and overall survival (log‐rank P = 0.379) was similar in both groups. Multivariable Cox proportional hazards model analysis indicated that VATS was not an independent predictor of recurrence‐free (hazard ratio 0.955, 95% CI 0.415–2.198; P = 0.913) or overall survival (hazard ratio 0.841, 95% CI 0.338–2.093; P = 0.709). Conclusion Compared to thoracotomy, VATS is a sufficient approach for MLND to treat locally advanced NSCLC following neoadjuvant therapy without compromising long‐term survival.
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Affiliation(s)
- Zhoujunyi Tian
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
| | - Xizhao Sui
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
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Kneuertz PJ, Singer E, D'Souza DM, Moffatt-Bruce SD, Merritt RE. Postoperative complications decrease the cost-effectiveness of robotic-assisted lobectomy. Surgery 2019; 165:455-460. [DOI: 10.1016/j.surg.2018.08.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/07/2018] [Accepted: 08/30/2018] [Indexed: 12/17/2022]
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Bailey KL, Merchant N, Seo YJ, Elashoff D, Benharash P, Yanagawa J. Short-Term Readmissions After Open, Thoracoscopic, and Robotic Lobectomy for Lung Cancer Based on the Nationwide Readmissions Database. World J Surg 2019; 43:1377-1384. [DOI: 10.1007/s00268-018-04900-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fang L, Wang L, Wang Y, Lv W, Hu J. Video assisted thoracic surgery vs. thoracotomy for locally advanced lung squamous cell carcinoma after neoadjuvant chemotherapy. J Cardiothorac Surg 2018; 13:128. [PMID: 30558629 PMCID: PMC6297983 DOI: 10.1186/s13019-018-0813-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/03/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Surgery is an important part of multidisciplinary treatment strategy for locally advanced lung squamous cell carcinoma (LSCC), but insufficient evidence supports the feasibility and safety of video assisted thoracic surgery (VATS) following neoadjuvant chemotherapy for locally advanced LSCC. This study aims to compare perioperative data and long-term survival of locally advanced LSCC patients between VATS and thoracotomy after neoadjuvant chemotherapy. METHODS We retrospectively collected the clinical and pathological information of patients with locally advanced LSCC who underwent surgical resection after neoadjuvant chemotherapy from October 2013 to October 2017. All patients were divided into two groups (thoracotomy and VATS) and were compared the differences in perioperative, oncological and survival outcomes. RESULTS A total of 81 patients were analyzed in this study (67 thoracotomy and 14 VATS). VATS provided less postoperative pain (P = 0.005) and produced less volume of chest drainage (P = 0.019) than thoracotomy, but the number of resected lymph nodes was less in VATS group (P = 0.011). However, there was no significant difference in the number of resected lymph node stations and the rate of nodal upstaging between two groups. The mean disease free survival (DFS) was 32.7 ± 2.7 months for the thoracotomy group and 31.8 ± 3.0 months for the VATS group (P = 0.335); the corresponding overall survival (OS) was 41.7 ± 2.2 months and 36.4 ± 4.1 months (P = 0.925). CONCLUSION In selected patients with locally advanced LSCC, VATS played a positive role in postoperative recovery and associated similar survival outcome compared with thoracotomy after neoadjuvant chemotherapy.
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Affiliation(s)
- Likui Fang
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Luming Wang
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yiqing Wang
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Wang Lv
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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Zhang L. Short- and long-term outcomes in elderly patients with locally advanced non-small-cell lung cancer treated using video-assisted thoracic surgery lobectomy. Ther Clin Risk Manag 2018; 14:2213-2220. [PMID: 30510426 PMCID: PMC6231434 DOI: 10.2147/tcrm.s175846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In recent years, video-assisted thoracic surgery (VATS) lobectomy has been used to treat locally advanced non-small-cell lung cancer (LA-NSCLC). However, VATS has not been reported in elderly patients (≥70 years) with LA-NSCLC. The purpose of this study was to compare short- and long-term outcomes of patients with LA-NSCLC aged ≥70 years and 55-69 years treated with VATS. PATIENTS AND METHODS From January 2012 to January 2018, a total of 83 patients with LA-NSCLC who were ≥55 years of age underwent VATS. Patients were divided into ≥70 years group (37 cases) and 55-69 years group (46 cases), based on their age at the time of VATS. Short- and long-term outcomes of these two groups of patients were compared. RESULTS American Society of Anesthesiologists scores of ≥70 years patients were higher than those of 55-69 years patients. No significant differences were observed when comparing the general preoperative data. For short-term outcomes, there was no significant difference between the two groups of patients in length of surgery, intraoperative blood loss, conversion to thoracotomy, postoperative 30-day complication rate and severity, postoperative 30-day mortality, pathological results, compliance with adjuvant chemotherapy, or other factors. Long-term follow-up results showed that recurrence, overall survival, and disease-free survival were similar in both groups. Furthermore, multivariate analysis showed that age was not an independent predictor of overall and disease-free survival. CONCLUSIONS VATS in elderly patients (≥70 years) with LA-NSCLC can result in short- and long-term outcomes similar to those of 55-69 years patients with LA-NSCLC.
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Affiliation(s)
- Like Zhang
- Department of Thoracic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, People's Republic of China,
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Ismail M, Nachira D, Swierzy M, Ferretti GM, Englisch JP, Ossami Saidy RR, Li F, Badakhshi H, Rueckert JC. Uniportal video-assisted thoracoscopy major lung resections after neoadjuvant chemotherapy. J Thorac Dis 2018; 10:S3655-S3661. [PMID: 30505549 DOI: 10.21037/jtd.2018.06.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background The combination of neoadjuvant chemotherapy and surgery in lung cancer therapy is well established. The role of uniportal video assisted thoracoscopy (VATS) is still not described in literature. This study presents the preliminary short-term results of uniportal VATS after neoadjuvant therapy in our series. Methods The prospectively collected data of 154 patients after uniportal VATS anatomical lung resection (18 patients after neoadjuvant chemotherapy and 136 surgeries alone) were retrospectively reviewed. The perioperative results and follow-up of patients after neoadjuvant therapy were analyzed and compared to those after surgery alone. Results The mean age of population was 67.51±10.63 years. The mean operative time was overlapping in both groups: 248.97±118.17 min in surgery group and 287.17±94.13 min in chemotherapy + surgery group (P=0.190), with no difference in terms of types of anatomical lung resections performed and number of lymph nodes retrieved. The intraoperative mortality was null in both groups. The incidence of all complications was the same in both groups and no correlations was found with any possible risk factor evaluated (age, gender, comorbidities, type of resection, histology, etc.). Among minor complications, the incidence of parenchymal fistula was significantly higher in the 18 patients underwent chemotherapy (22.2% vs. 5.1% respectively, P=0.013). The overall survival of the series was 93% at 1 year follow-up and 88% at 5-year. The 1- and 2-year survival in only surgery group was 94% and 89% respectively vs. 85% and 85% in Chemotherapy + surgery, without any significant difference (P=0.324). Conclusions According to our experience, uniportal VATS after neoadjuvant therapy is feasible and quite safe. The oncological results and postoperative complications are comparable to those of other techniques. Uniportal VATS can be performed even for complicated cases in experienced centers.
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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" IRCCS, Catholic University of the Sacred Heart, 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" IRCCS, Catholic University of the Sacred Heart, 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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Matsuoka K, Yamada T, Matsuoka T, Nagai S, Ueda M, Miyamoto Y. Video-assisted thoracoscopic surgery for lung cancer after induction therapy. Asian Cardiovasc Thorac Ann 2018; 26:608-614. [DOI: 10.1177/0218492318804413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Although thoracoscopic surgery is widely performed for early-stage lung cancer, only a few small studies have evaluated the role of video-assisted thoracoscopic surgery in patients with locally advanced lung cancer who had received preoperative chemotherapy. Methods Among 1655 patients who underwent anatomical lung resection for lung cancer between January 2009 and December 2014 in our institution, we retrospectively examined the short- and long-term outcomes of 110 (6.6%) who had undergone induction therapy. Thoracoscopic surgery was performed in 79 of these patients and thoracotomy in 31. Results In the thoracoscopic group, conversion to a thoracotomy was required in 4 patients. More combined resections were included in the thoracotomy group, and combined resection of large vessels or the carina was carried out only via a thoracotomy. Postoperative complications of grade 3 or above were found in 15 (13.6%) patients, and there was no significant difference in the incidence of postoperative complications between the 2 groups. The 3- and 5-year survival rates for the patients overall were 58.6% and 50.3%, respectively. Although there was no significant difference in overall outcome between the 2 groups, the patients with postoperative ypN2 status in the thoracoscopic group had a significantly better outcome than those in the thoracotomy group. Conclusion Although video-assisted thoracoscopic surgery was not suitable for central advanced lung cancer requiring angioplasty or carinal resection, it seems to be useful for patients with locally advanced lung cancer who had undergone induction therapy, especially patients with peripheral lung cancer and mediastinal lymph node metastasis.
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Affiliation(s)
- Katsunari Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji-City, Hyogo, Japan
| | - Tetsu Yamada
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji-City, Hyogo, Japan
| | - Takahisa Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji-City, Hyogo, Japan
| | - Shinjiro Nagai
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji-City, Hyogo, Japan
| | - Mitsuhiro Ueda
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji-City, Hyogo, Japan
| | - Yoshihiro Miyamoto
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji-City, Hyogo, Japan
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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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Veronesi G, Bonovas S. Similar results of robotic and uniportal videothoracoscopic surgery for lung cancer treatment. J Thorac Dis 2018; 10:S1064-S1066. [PMID: 29850186 DOI: 10.21037/jtd.2018.03.88] [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)
- Giulia Veronesi
- Division of Thoracic and General Surgery, Humanitas Cancer Center, Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Yang Z, Zhai C. Uniportal video-assisted thoracoscopic surgery following neoadjuvant chemotherapy for locally-advanced lung cancer. J Cardiothorac Surg 2018; 13:33. [PMID: 29690894 PMCID: PMC5937806 DOI: 10.1186/s13019-018-0714-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several retrospective studies have confirmed that video-assisted thoracoscopic surgery (VATS) following neoadjuvant chemotherapy is a safe and feasible treatment for advanced non-small cell lung cancer patients. As a minimally invasive technique, VATS usually leads to better clinical outcomes and better compliance with adjuvant treatment than conventional thoracotomy. Uniportal VATS (U-VATS) as an alternative option to conventional multi-port VATS has attracted much attention recently because reduced number and size of incisions may help to decrease inflammatory response and reduce postoperative pain for patients. However, rarely studies have reported the application of U-VATS following neoadjuvant chemotherapy for the treatment of advanced lung cancer patients. METHODS A total of 29 lung cancer patients undergoing VATS following neoadjuvant chemotherapy were included in this study. The clinical data of these patients were retrospectively analyzed, including the preoperative neoadjuvant chemotherapy plan, surgical effect, postoperative complications, operation time, operative blood loss, number of lymph nodes dissected and postoperative mortality. RESULTS All patients underwent VATS following two cycles of neoadjuvant chemotherapy. Among these patients, 26 completed U-VATS, two were converted to triple-port VATS, and one was converted to open thoracotomy. The operation time ranged from 120 min to 300 min (mean: 160 ± 38.5 min); the operative blood loss was 50-500 ml (mean:167.8 ± 78.4 ml); the number of lymph nodes dissected was 16-28 (mean: 21.9 ± 3.7); the postoperative drainage time was 3-13 d (mean: 5.6 ± 1.9 d); and the postoperative hospital stay was 6-16 d (7.7 ± 1.9 d). Postoperative complications occurred in five (17.2%) patients, including three cases of respiratory infection, one case of air leakage (more than two weeks), and one case of wound infection. In addition, the 30- and 90-day postoperative mortality was zero. CONCLUSION U-VATS following neoadjuvant chemotherapy is feasible and safe for the treatment of advanced lung cancer patients.
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Affiliation(s)
- Zhiqiang Yang
- Department of Thoracic Surgery, Weifang People's Hospital, Shandong Province, Weifang, 261041, China
| | - Chunbo Zhai
- Department of Thoracic Surgery, Weifang People's Hospital, Shandong Province, Weifang, 261041, China.
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Bertolaccini L, Pardolesi A, Solli P. Video-assisted thoracic surgery for extended lung cancer disease: moving into the borderlands. J Vis Surg 2017; 3:40. [PMID: 29078603 DOI: 10.21037/jovs.2017.02.09] [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)
- Luca Bertolaccini
- Department of Thoracic Surgery, AUSL Romagna - Ravenna Teaching Hospital, Ravenna, Italy
| | - Alessandro Pardolesi
- Department of Thoracic Surgery, AUSL Romagna - Forlì Teaching Hospital, Forlì, Italy
| | - Piergiorgio Solli
- Head of Department of Thoracic Surgery, AUSL Romagna - Ravenna and Forlì Teaching Hospital, Ravenna and Forlì, Italy
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Ricciardi S, Cardillo G, Zirafa CC, Davini F, Melfi F. Robotic lobectomies: when and why? J Vis Surg 2017; 3:112. [PMID: 29078672 DOI: 10.21037/jovs.2017.07.09] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/11/2017] [Indexed: 01/28/2023]
Abstract
During the last decade, an abundance of papers has supported minimally invasive pulmonary resections (MIPR) vs. traditional open approach. Both video assisted thoracic surgery (VATS) and robotic thoracic surgery have shown better perioperative outcomes and equivalent oncologic results compared with thoracotomy, confirming the effectiveness of the MIPR. Despite the profound changes and improvements that have taken place throughout the years and the increasing use of robotic system worldwide, the controversy about the application of robotic surgery for lung resections is still open. Some authors wonder about the advantages of using a more expensive and more complex platform for thoracic surgery instead of the more established VATS technique. Robotic thoracic surgery represents, although the cumulative experience worldwide is still limited and evolving, a significant evolution over VATS, nonetheless several authors criticize the longer operative time and the high costs of robotic procedures. The aim of this paper is to answer two relevant questions: why and when the application of robotic technology in thoracic surgery is appropriate?
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Affiliation(s)
- Sara Ricciardi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Federico Davini
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Franca Melfi
- Multidisciplinary Center of Robotic Surgery, Unit of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
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Oskarsdottir GN, Halldorsson H, Sigurdsson MI, Fridriksson BM, Baldvinsson K, Orrason AW, Jonsson S, Planck M, Gudbjartsson T. Lobectomy for non-small cell lung carcinoma: a nationwide study of short- and long-term survival. Acta Oncol 2017; 56:936-942. [PMID: 28325129 DOI: 10.1080/0284186x.2017.1304652] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Lobectomy is the standard curative treatment for non-small cell carcinoma (NSCLC) of the lung. Most studies on lobectomy have focused on short-term outcome and 30-day mortality. The aim of this study was to determine both short-term and long-term surgical outcome in all patients who underwent lobectomy for NSCLC in Iceland over a 24-year period. MATERIAL AND METHODS The study involved 489 consecutive patients with NSCLC who underwent lobectomy with curative intent in Iceland, 1991-2014. Patient demographics, pTNM stage, rate of perioperative complications, and 30-day mortality were registered. Overall survival was analyzed with the Kaplan?Meier method. The Cox proportional hazards model was used to evaluate factors that were prognostic of overall mortality. To study trends in survival, the study period was divided into six 4-year periods. The median follow-up time was 42 months and no patients were lost to follow-up. RESULTS The average age of the patients was 67 years and 53.8% were female. The pTNM disease stage was IA in 148 patients (30.0%), IB in 125 patients (25.4%), IIA in 96 patients (19.5%), and IIB in 50 patients (10.1%), but 74 (15.0%) were found to be stage IIIA, most often diagnosed perioperatively. The total rate of major complications was 4.7%. Thirty-day mortality was 0.6% (three patients). One- and 5-year overall survival was 85.0% and 49.2%, respectively, with 3-year survival improving from 48.3% to 72.8% between the periods 1991-1994 and 2011-2014 (p = .0004). Advanced TNM stage and age were independent negative prognostic factors for all-cause mortality, and later calendar year and free surgical margins were independent predictors of improved survival. CONCLUSIONS The short-term outcome of lobectomy for NSCLC in this population-based study was excellent, as reflected in the low 30-day mortality and low rate of major complications. The long-term survival was acceptable and the overall 3-year survival had improved significantly during the study period.
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Affiliation(s)
- G. N. Oskarsdottir
- Departments of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
- Department of Pulmonology, Skåne University Hospital, Lund, Sweden
| | - H. Halldorsson
- Departments of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | - M. I. Sigurdsson
- Departments of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | - B. M. Fridriksson
- Departments of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | - K. Baldvinsson
- Departments of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | - A. W. Orrason
- Departments of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | - S. Jonsson
- Departments of Pulmonology, Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - M. Planck
- Department of Pulmonology, Skåne University Hospital, Lund, Sweden
| | - T. Gudbjartsson
- Departments of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Veronesi G, Novellis P, Difrancesco O, Dylewski M. Robotic assisted lobectomy for locally advanced lung cancer. J Vis Surg 2017; 3:78. [PMID: 29078641 DOI: 10.21037/jovs.2017.04.03] [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] [Received: 03/26/2017] [Accepted: 04/11/2017] [Indexed: 11/06/2022]
Abstract
Some series report the use of video-assisted thoracic surgery (VATS) in patients with locally advanced non-small cell lung cancer (NSCLC) but, few studies describe the use of the robotic approach specifically for locally advanced disease. One potential advantage of the robotic approach over traditional VATS is the increased radicality. While the benefit of the robotic approach over open thoracotomy is directly related to reduced surgical trauma and the improved tolerability in fragile patients that have received induction treatment. In case of occult N2 disease, robotic assisted surgery can translate into a quicker recovery with improved compliance with adjuvant treatments following surgery. Technical details are reported and described. The robotic instrument technology allows sharp and controlled dissection compared to the typical blunt sweeping methods used in most VATS lobectomy techniques. The authors believe that robotic technology favors a more radical resection in the case of complex locally advanced tumors. Robotic technology has some limitations that have affected adoption such as significant capital and maintenance costs, reduced operating room efficiencies, and a steep learning curve.
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Affiliation(s)
- Giulia Veronesi
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Pierluigi Novellis
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Orazio Difrancesco
- Department of Anesthesia and Intensive Care Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Mark Dylewski
- Thoracic and Robotic Surgery, Baptist Health of South Florida, Miami, Florida, USA
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Turner SR, Latif MJ, Park BJ. Robotic assisted VATS lobectomy for loco-regionally advanced non-small cell lung cancer. VIDEO-ASSISTED THORACIC SURGERY 2017; 2. [PMID: 30198013 DOI: 10.21037/vats.2017.02.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Despite lung cancer screening programs and efforts at early detection, patients with non-small cell lung cancer continue to present with loco-regionally advanced disease. In particular, patients with positive mediastinal lymph nodes (N1/2, stage II/IIIA) present a challenge to the thoracic surgeon. The thorough lymphadenectomy required by these patients can be difficult to perform with standard VATS approaches. In addition, hilar fibrosis may result from the neoadjuvant therapy these patients generally receive, which complicates dissection of the vascular and bronchial structures. The robotic approach offers benefits that can help to address these challenges. While not ideal for the surgeon just learning robotic surgery, in experienced hands this is an effective tool to deal with loco-regionally advanced lung cancer safely and with optimal oncologic efficacy.
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Affiliation(s)
- Simon R Turner
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M Jawad Latif
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Bernard J Park
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, USA
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Xu Y, Chen N, Wang Z, Zhang Y, Mei J, Liu C, Liu L. Should primary tumor be resected for non-small cell lung cancer with malignant pleural disease unexpectedly found during operation?-a systemic review and meta-analysis. J Thorac Dis 2016; 8:2843-2852. [PMID: 27867560 DOI: 10.21037/jtd.2016.10.19] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) with malignant pleural disease (MPD) was considered to be contraindication for surgery, but sometimes MPD was unexpectedly found intraoperatively. There was no consensus on the role of surgical intervention on the primary tumor in patients with MPD. The object of this research was to assess whether exairesis of primary tumor could prolong survival time. METHODS A systemic research of literature was performed on the databases of PubMed, Embase and Web of Science. Literatures examining surgical benefit or other prognostic factors among NSCLC patients with MPD unexpectedly found during operations were included. Hazard ratio (HR) with 95% confidence interval (95% CI) as well as P value is applied for prognostic role of surgical removal or other potential factors. RESULTS Nine articles with a total number of 861 patients fulfilled the eligibility criteria, five of them compared the survival benefit between exploration and resection among NSCLC patients with unexpected MPD, and other studies also investigated the prognostic factors in these patients. There was a significant survival benefit in patients with primary tumor resection (HR =0.443; 95% CI: 0.344-0.571; P<0.001). This role was further detected when stratified by analysis method and ethnicity. Female was an independent favorable predicted factor (HR =0.788; 95% CI: 0.648-0.959; P=0.017) while higher N-stage was a risk factor (HR =1.879; 95% CI: 1.307-2.701; P=0.001). Among patients who received primary tumor resection, higher N-stage was also a risk factor for poorer survival (HR =2.021; 95% CI: 1.496-2.730; P<0.001). CONCLUSIONS Resection of primary tumor, female and lower-N stage were suggested to be beneficial prognostic factor among NSCLC patients who were detected with MPD for the first time in the operating room. And among these people who received surgical removal of primary tumor, lower N-stage also indicated a better survival.
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Affiliation(s)
- Yuyang Xu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;; West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;; West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Zihuai Wang
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Yingyi Zhang
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chengwu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
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Toosi K, Velez-Cubian FO, Glover J, Ng EP, Moodie CC, Garrett JR, Fontaine JP, Toloza EM. Upstaging and survival after robotic-assisted thoracoscopic lobectomy for non-small cell lung cancer. Surgery 2016; 160:1211-1218. [PMID: 27665362 DOI: 10.1016/j.surg.2016.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/07/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mediastinal involvement in resected non-small-cell lung cancer mandates adjuvant therapy and affects survival. This study investigated lymph node dissection efficacy, lymph node metastasis detection, and survival after robotic-assisted lobectomy for non-small-cell lung cancer. METHODS We retrospectively analyzed patients who underwent robotic-assisted lobectomy for non-small-cell lung cancer. Survival was assessed through chart reviews, Social Security Death Registry, and national obituary searches. Kaplan-Meier survival curves by clinical and pathologic stage were compared by log-rank and Cox regression analysis. RESULTS In 249 patients (mean age, 67.8 ± 0.6 years), mean individual mediastinal lymph nodes retrieved was 7.7 ± 0.3 lymph nodes, with mean of 13.9 ± 0.4 N1+ mediastinal lymph nodes. There were 159 (63.9%) clinical stage I versus 134 (53.8%) pathologic stage I patients, with 67 (26.9%) patients upstaged (20 cN0 to pN1; 17 cN0 to pN2; 4 cN1 to pN2) and 37 (14.9%) downstaged. One-year and 3-year survival rates, respectively, changed between clinical stage I (clinical stage I, 91% and 70%; clinical stage II, 80% and 64%; clinical stage III, 78% and 57%; clinical stage IV, 71% and 45%) and pathologic stage (pathologic stage I, 92% and 75%; clinical stage II, 83% and 73%; pathologic stage III, 75% and 44%; and pathologic stage IV, 67% and 0%). CONCLUSION Mediastinal lymph node dissection during robotic-assisted lobectomy adequately assesses lymph node stations and detects occult lymph node metastasis. Stage-specific survival is affected by upstaging.
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Affiliation(s)
| | | | | | | | - Carla C Moodie
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL
| | - Joseph R Garrett
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL
| | - Jacques P Fontaine
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL; Department of Surgery, University of South Florida, Tampa, FL; Department of Oncologic Sciences, University of South Florida, Tampa, FL
| | - Eric M Toloza
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL; Department of Surgery, University of South Florida, Tampa, FL; Department of Oncologic Sciences, University of South Florida, Tampa, FL.
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