Trends In Segmentectomy For The Treatment Of T1a And T1b Non-small Cell Lung Cancers: Does The Robot Have An Impact
Alexander Leung, Akbarshakh Akhmerov, Monica Justo, Abigail Fong, Amirhossein Mahfoozi, Harmik Soukiasian, Taryne Imai.
Cedars-Sinai, Los Angeles, CA, USA.
BACKGROUND: Lung cancer screening programs have enabled cancers to be detected at earlier stages and smaller sizes. Lobectomy, traditionally the gold standard, may unnecessarily resect healthy lung parenchyma; segmentectomies may be a better option as a lung-sparing resection. VATS segmentectomies can be technically challenging; robotic utilization may facilitate the performance of segmentectomies. With increasing robotic adoption, we investigate trends in segmentectomies performed relative to lobectomies and assess trends by surgical approach for patients with T1a and T1b non-small cell lung cancers(NSCLC). METHODS: The National Cancer Database(2010-2017) was queried for patients with T1a and T1b NSCLC who underwent lobectomies and segmentectomies. The proportion of segmentectomies vs. lobectomies was calculated annually for all approaches (open, VATS and robotic) and separately for stage T1a and T1b patients. The proportion of segmentectomies performed by VATS vs. robot per year was also investigated. RESULTS:104,359 patients underwent lobectomy(91%, N=95,298) and segmentectomy(8.7%, N=9,049). Minimally-invasive(MIS) segmentectomies(in 2012) and MIS lobectomies(in 2015) steadily became more frequent than open segmentectomies(Figure 1A). For all approaches, the proportion of segmentectomies performed per year ranged from 7.4% to 9.6% with lobectomies being the majority(Figure 1B). With MIS approaches, the proportion of segmentectomies remained constant throughout the years, ranging from 10.6% to 11.4% relative to lobectomies(Figure 1B). This trend was similar when T1a and T1b patients were analyzed separately (T1a segmentectomies ranging from 11.8% to 13.6%; T1b ranging from 6.8% to 9.2%). Comparing MIS segmentectomies, 13.3% were performed robotically in 2010; increased to 33.4% in 2017. Both the T1a and T1b groups demonstrated an increasing trend in robotic segmentectomy (T1a 13.4% in 2010 and 34.6% in 2017; T1b 3.9% in 2010 and 29.7% in 2017) (Figure 1C). CONCLUSIONS:Trends in the proportion of segmentectomies and lobectomies, for the treatment of T1a and T1b NSCLC, have remained relatively constant throughout the years. However, MIS approaches for both segmentectomy and lobectomy have now surpassed open surgery, which may be due to the increasing utilization of the robotic platform. We demonstrate an increasing trend and proportion of robotic segmentectomies being performed in comparison to VATS segmentectomies. The robotic platform may facilitate the performance of more segmentectomies for early-stage NSCLC. 
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