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The Role Of Lymphadenectomy In Clinical Stage I Nsclc: Comparison Of Robotic And Open Approach
Beatrice Manfredini, Carmelina Cristina Zirafa, Greta Alì, Gaetano Romano, Ilaria Ceccarelli, Federico Davini, Franca Melfi;
University of Pisa, Pisa, Italy
BACKGROUND: Lobectomy with lymphadenectomy is considered the gold-standard treatment for NSCLC. The extent of required lymphadenectomy and its impact on survival and recurrence in early-stage is currently a matter of debate. In the last decades, the use of robotic approach has given promising results. Features of robotic technique could consent a lymph nodal dissection similar to open surgery. This study aims to compare lymphadenectomy between thoracotomy and robotic approaches and to analyze the role of lymph node dissection on survival and recurrence in patients undergoing lobectomy with lymphadenectomy for clinical stage I NSCLC.
METHODS: Data of all patients who underwent lobectomy and lymphadenectomy by robotic or open surgery for stage cI NSCLC from 2016 to 2019 were retrospectively collected and analysed. Preoperative and intraoperative results and details regarding lymphadenectomy (mean number of lymph nodes removed, number and type of lymph node locations explored) were investigated and hence their impact on OS, CSS, and DFS.
RESULTS: Over the period considered, 197 patients underwent pulmonary lobectomy and lymphadenectomy with robotic (142, 72.1%) or open (55, 27.9%) techniques. A mean of 12.2 (1-35) lymph nodes were removed in the robotic group, while a mean of 13.8 (3-33) in the open group. In both cases a mean of 3 (1-5) N2 lymph node stations were analysed. Perioperative results showed a similar surgical time [robot 142 (115-535); open 122 (50-340)] between the two groups, and a lower length of stay [6 (3-19); 7 (4-24)], duration of chest tube [5 (1-36); 6 (3-27)] and complication rate (20% vs 31%) in the robotic group. The Statistical analysis showed that the evaluated lymph nodal factors in the total cohort did not statistically significantly impact OS, CSS, and DFS, at a mean follow-up of 58 months.
CONCLUSIONS: The results of this study show how the robotic approach allows for a lymphadenectomy similar to the open technique, with better perioperative outcomes. Furthermore, this study suggests that systematic lymphadenectomy should not be methodically performed in the event of an accurate preoperative clinical staging leading to the identification of the early-stage NSCLC. Future prospective randomized trials are needed to confirm these data.
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