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International Society For Minimally Invasive Cardiothoracic Surgery

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Robot Assisted Thoracic Surgery For Higher Stages Non-small Cell Lung Cancer: Feasibility And Outcome
Ghada M. Shahin1, Peter Paul W. Vos2, Jos A. Stigt3.
1Leids Universitair Medisch Centrum, Leiden, Netherlands, 2Universitair Medisch Centrum Utrecht, Utrecht, Netherlands, 3Isala, Zwolle, Netherlands.

BACKGROUND: Robot assisted surgical resection of early-stage Non-Small Cell Lung Carcinoma (NSCLC) is well described, however not for higher stages of lung cancer. The aim of this study is to report on feasibility and safety of robot assisted thoracic surgery (RATS) in patients with stages IIb to IVa lung cancer. Outcome is described by the rate of conversions, R0 resections and local recurrence.
METHODS: This single institute retrospective study was conducted in patients who underwent RATS for locally advanced lung cancer and patients with oligometastatic disease. Inclusion criteria were either clinical or pathological stage IIb-IVa. Exclusion criteria were unexpected N2 disease, Small Cell Lung Carcinoma and benign lesions. Data were obtained from the National Lung Cancer Data base as well as hospital database.
RESULTS: From January 2015 to January 2020, 96 patients, mean age of 70 years (SD 9.80), 67% male, stages IIb (N=53), IIIa (N=38), IIIb (N=2) and IVa (N=3) underwent RATS, (50% adenocarcinoma, 43.8% squamous cell carcinoma, 5.2% carcinoids and 1% large cell carcinoma). Ten patients (10.4%) received chemoradiotherapy prior to surgery.The majority of resections were lobectomies (71.9%). RATS could be completed in 76.1% and was converted to thoracotomy in 23.9%, of which 20.8% electively, mostly due to bulkiness of the tumor. Emergency conversion was necessary in 3.1% (N=3) all due to bleeding and all in the first half of the study period. Total In-hospital mortality was 2.1% (N=2), one due to intra-operative hemorrhage. In 82.5% blood loss was less than 500mls. The R0 resection rate was 94.8%. Within the mean follow-up time of 2.3 years (SD 1.3 years) 73.4% of the patients is alive, local recurrence rate was 7.9%, distant metastasis rate was 16.9%, and 16.9% developed both local recurrence and distant metastases. CONCLUSIONS:RATS could be completed in 76.1% of patients with higher stages NSCLC, with an R0 resection rate of 94.8% and a local recurrence rate of 7,9%.RATS was electively converted to thoracotomy in 20,8% of patients due to bulkiness of the tumor and risk of bleeding.

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