The long-term survival of robotic lobectomy for non–small cell lung cancer: A multi-institutional study

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 155; no. 2; pp. 778 - 786
• Main Authors: Cerfolio, Robert J., Ghanim, Asem F., Dylewski, Mark, Veronesi, Giulia, Spaggiari, Lorenzo, Park, Bernard J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2018
• Subjects: Adult; Aged; Aged, 80 and over; Blood Loss, Surgical - prevention & control; Blood Transfusion; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - secondary; Carcinoma, Non-Small-Cell Lung - surgery; Databases, Factual; Female; Humans; Italy; Length of Stay; lung cancer; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Operative Time; Pneumonectomy - adverse effects; Pneumonectomy - methods; Pneumonectomy - mortality; Postoperative Complications - mortality; Postoperative Complications - therapy; quality outcomes; Retrospective Studies; robotic surgery; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Robotic Surgical Procedures - mortality; survival; Time Factors; Treatment Outcome; United States; Young Adult; United States; Italy; lung cancer; CT; VATS; quality outcomes; NSCLC; survival; UAB; EBUS; PET; robotic surgery
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2017.09.016

Our objective is to report the world's largest series with the longest follow-up of robotic lobectomy for non–small cell lung cancer (NSCLC).
This was a multi-institutional retrospective review of a consecutive series of patients from 4 institutions' prospective robotic databases.
There were 1339 patients (men 55%, median age 68 years). The median operative time was 136 minutes, median number of lymph nodes was 13 (5 N2 stations and 1 N1), median blood loss was 50 cc, and 4 (0.005%) patients received intraoperative transfusions. Conversions occurred in 116 patients (9%) and for bleeding in 24 (2%). Median length of stay was 3 days. Major morbidity occurred in 8%. The 30-day and 90-day operative mortality was 0.2% and 0.5%, respectively. Follow-up was complete in 99% of patients with a median follow-up of 30 months (range 1-154 months). The 5-year stage-specific survival was: 83% for the 672 patients with stage IA NSCLC, 77% for the 281 patients with stage IB, 68% for the 118 patients with stage IIA, 70% for 99 patients with IIB, 62% for 143 patients with stage IIIA (122 had N2 disease, 73%), and 31% for 8 patients with stage IIIB (none had N3 disease). The cumulative incidence of metastatic NSCLC was 15% (128 patients, 95% confidence interval, 13%-18%). The cumulative incidence of local recurrence in the ipsilateral operated chest was 3% only (26 patients, 95% confidence interval, 2%-5%).
The oncologic results of robotic lobectomy for NSCLC are promising, especially for patients with pathologic N2 disease. However, further follow-up and studies are needed.