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Robotic Lobectomy for Early Stage Lung Cancer of a Right Upper Lobectomy
Mark Meyer, Barbara Tempesta, Eric Strother, Marc Margolis, Farid Gharagozloo.
Washington Institute of Thoracic and Cardiovascular Surgery at The GW University Medical Center, Washington, DC, USA.
BACKGROUND: Robotic lobectomy has been evolving over the past decade and has been shown to be feasible. We report the outcomes of a large series of patients that underwent robotic lobectomy.
METHODS: From January 2004 until November 2011, we performed a retrospective review of prospectively accrued patients at our institution that underwent robotic lobectomy. From this cohort, patients that underwent robotic lobectomy for early stage lung cancer were included in the study.
RESULTS: 203 patients underwent robotic lobectomy. 174 patients underwent robotic lobectomy for early stage lung cancer (Stage I or II). There were 71 men and 103 women with a mean age of 65+/-10.3 years of age. Lobectomies were right upper (47), right middle (14), right lower (30), left upper (46), and left lower (27), lingulectomies (8), and bilobectomies (2). Mean operating room time for a single surgeon with the first 20 cases was 337 +/- 31 minutes and with the last 73 cases was 198 +/-50 minutes. Tumor type was adenocarcinoma (106), squamous cell carcinoma (39), adenosquamous carcinoma (9), bronchoalveolar (4), large cell (4), poorly differentiated (3), carcinoid (7), mucoepidermoid (1), spindle cell (1). Pathologic upstaging was noted in 31/174 (18%) patients. There were 2 /172 (1.2 %) emergent conversions to a thoracotomy for bleeding from the pulmonary artery. There were 4/174 (2.3%) nonemergent conversions to thoracotomy (1 for suspected dural leak, 2 for a calcified bronchus, 1 for an incomplete fissure). There were no intraoperative deaths. Postoperative mortality was 1.7%. There were no deaths among the last 154 patients. Minor complications were seen in 34/174 (19.5%) patients. Median hospitalization was 5 days. At a median follow up of 41 months, 4/174 (2.3%) patients died from their lung cancer, 8/174 (4.6%) patients had metastatic disease, and 2/174 (1.1%) patients had a second lung primary cancer. There was no local recurrence.
CONCLUSION: Robotic lobectomy is feasible and safe with comparable morbidity to thoracotomy and VATS approaches. The results improve after twenty cases. The oncologic advantage of robotic lobectomy in upstaging early stage lung cancer may be due to enhanced bronchovascular as well as mediastinal node dissection.
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