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OBJECTIVE: Background: Lobectomy is the gold standard for the treatment of early-stage non-small cell lung cancer (NSCLC). Anatomic segmentectomy is advocated for curative resection in select patients. We investigated the safety and oncologic efficacy of robot-assisted anatomic segmentectomy with mediastinal nodal dissection.
METHODS: Methods: We retrospectively reviewed patients who underwent robot-assisted anatomic segmentectomy for early-stage NSCLC. Robotic dissection of the main bronchovascular structures was followed by division of respective segmental structures and mediational nodal dissection. Follow-up data was obtained to determine survival, along with statistically significant risk factors in both univariate and multivariate models.
RESULTS: Results: 153 patients underwent robot-assisted anatomic segmentectomy. Selection criteria included poor pulmonary function, and advanced age. There were 78 men, 75 women, mean age 70+/-12 years. All patients underwent R0 resection. Mean operating time was 134 minutes. 24/153 patients (16%) were upstaged. 19/24 patients were upstaged due to size of tumor in the pathologic specimen (>3cm), and 5/24 patients were upstaged due to microscopic nodal metastasis. Median hospitalization was 7 days (2-31 days). Complication rate was 29%. There was no 30-day mortality. Mean follow-up was 30 months (range 2 months to 9 years) in 145/153(95%) patients. Overall 5-year survival was 43%, while lung cancer-specific 5-year survival was 55%. 5-year lung cancer-specific survival for pathologic stage I disease was 73%. Local or mediastinal recurrence occurred in 7/145 (5%) patients. Pathologic upstaging or recurrence resulted in 0% 5-year survival. Univariate and multivariate analysis showed that advanced age and pathologic upstaging were statistically significant risk factors for lung cancer-specific death.
CONCLUSIONS: Robotic segmentectomy with mediastinal nodal dissection is a safe and oncologically efficacious procedure. Accurate preoperative clinical staging is of critical importance in long term survival.