Locally Advanced: The Role Of Robotic Approach
Elisa Sicolo1, Carmelina Cristina Zirafa2, Elena Bagala2, Gaetano Romano1, Federico Davini1, Franca Melfi1.
1Division of Thoracic Surgery, Department of Surgical Medical and Molecular pathology and Critical Area, University Hospital of Pisa, Italy, Pisa, Italy, 2Minimally invasive and robotic thoracic surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Pisa, Italy.
BACKGROUND: Locally advanced lung cancer includes a heterogenous group of patients depending on tumor dimension (T3-T4) and lymph node involvement (N1-N2). This study aims to evaluate the safety, feasibility and radicality of the use of robotic surgery to perform anatomic resection in locally advanced Non-Small Cell Lung Cancer (NSCLC).
METHODS: Data of 61 consecutive patients with locally advanced NSCLC (cIIIA-IIIB) who underwent robotic anatomic resection, from 2010 to 2021, has been analyzed and compared with data of 70 consecutive patients treated by thoracotomy. It was evaluated operative, post-operative and oncologic results.
RESULTS: In robotic group, there were 61 patients with a median age of 67.33 years (range 32-80), with a median operative time of 256 minutes (range 120-440) and a median postoperative hospital stay of 7 days (range 2-27). Post-operative complications occurred in 28 patients (45.9%).The open group included of 70 patients with a median age of 69.44 years (range 48-82), with a median operative time of 131 minutes (range 60-235), and a median postoperative hospital stay of 9 days (range 4-48). Post-operative complications were verified in 36 patients (51.4%).
Analyzing oncologic outcomes of the robotic group, loco-regional recurrence was observed in 29 patients (47.5%), distant metastases in 37 patients (60.6%); the 5-year OS was 34% (Figure). In the open group, loco-regional recurrence was detected in 30 patients (42.8%), distant metastases in 41 patients (58.6%); the 5-year OS was 31% (Figure).No statistically significant differences were observed in terms of postoperative complications and oncological results. CONCLUSIONS: Our experience confirms that the robotic approach is safe and feasible in terms of postoperative mortality and incidence of complications, when performed by skilled surgeons.The long term oncological outcomes are in line with the most consistent open surgery results, confirming that robotic approach is associated with oncological radicality.LEGEND: Overall survival 
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