Is There Any Value To Robotic Assisted Lobectomy For Lung Cancer?
David Rice, Reza Mehran, Arlene Correa, Mara Antonoff, Wayne Hofstetter, Jack Roth, Boris Sepesi, Stephen Swisher, Garrett Walsh, Ara Vaporciyan.
University of Texas MD Anderson Cancer Center, Houston, TX, USA.
OBJECTIVE: It is unclear whether the enhanced dexterity and visualization of the surgical robot lessens morbidity or influences staging or survival. We compared outcomes of robotic-assisted lobectomy (RAL) with thoracoscopic (VATS) and open lobectomy.
METHODS: Using a prospective surgical database perioperative and cancer related outcomes of patients who underwent lobectomy for primary lung cancer by robotic, thoracoscopic or open approaches, between 2011 and 2016, were analyzed.
RESULTS: There were 825 patients, of which 94 (11.3%) had RAL, 250 (30%) VATS, and 481 (58%) open lobectomy. Patients in the RAL group were older (70 yrs) compared to VATS or open cohorts (Table). No differences in comorbidities existed. Compared to VATS there were more c-stage II/III tumors in the RAL group (24% vs. 10%, p=0.002), tumors were larger (3.0cm vs. 2.4cm, p<0.001) and there was a trend towards more neoadjuvant treatment (12% vs. 6%, p=0.065). Operative times were longer for RAL (229 min) compared to VATS and open lobectomy (170 and 176 min, respectively, p<0.001). However, RAL was associated with less blood loss and more nodal stations resected (Table). The only difference between groups in perioperative events was more frequent postoperative transfusion for RAL (9%) vs. VATS (3%, p=0.046) and fewer prolonged air leaks compared with open lobectomy patients (1% 6%, p=0.044). RAL was associated with shorter length of stay than open lobectomy (4 vs. 5 days, p<0.001) but was equivalent to VATS (4 days). No significant differences existed between groups regarding upstaging or stage-specific survival. Hospital charges were significantly higher for RAL compared to VATS and open lobectomy, (36% and 10% higher, respectively p<0.001).
CONCLUSIONS: Compared to VATS patients who had RAL were older with larger, more advanced c-stage tumors, and yet perioperative outcomes and long-term survival were virtually equivalent. Though significantly more expensive than either VATS or open lobectomy, the value of RAL may be that it may enable higher risk patients or those with more advanced stage tumors to benefit from a minimally invasive approach.
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