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Objective: One advantage of the application of robotics for lung resection in patients with non-small cell lung cancer may be the ability to provide greater mediastinal nodal dissection with robotic instruments. Large series have shown upstaging after robotic mediastinal nodal dissection is up to 21%, compared to 11.6% in VATS groups and 14.3% in open groups. We reviewed our experience with upstaging in patients who underwent robotic lobectomy.
Methods: Patients with clinical stage I or II lung cancer who underwent robotic lobectomy and MLNE were included in this retrospective study. Pathologic nodal upstage rates were determined for N0 to N1 and N0 to N2 disease. A review of recent literature on upstage rates for different surgical approaches was also performed.
Results: 189 patients underwent robotic lobectomy with mediastinal nodal dissection for early stage lung cancer. 10 patients were excluded based on not being candidates for robotic surgery. Mean operating time was 162+/-93 minutes. Tumor type included adenocarcinoma 109, squamous cell carcinoma 36, adenosquamous carcinoma 10, bronchoalveolar 16, giant cell 6, and poorly differentiated 2. Overall pathologic upstaging was noted in 31/179 patients (17.3%). N0 to N1 rate of 10.1% (18/179), and N0 to N2 rate of 7.3% (13/179). Median hospitalization was 6 days. Complications included atrial fibrillation, prolonged air leak, atelectasis, and pneumonia.
Conclusion: Robotic lung resection and mediastinal nodal dissection is safe and efficacious by virtue of thorough removal of lymph nodes. This may increase the oncologic efficacy of video assisted thoracoscopic surgery.