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Is Tissue Still The Issue: Robotic Segmentectomy Without Preoperative Tissue Diagnosis For The Solitary Pulmonary Nodule
Alex Weyler1, Khamil Abbas
1, Chudnovets Anna
2, Argenis Herrera
2, Sandeep Kashyap
2, Ghulam Abbas
2.
1West Virginia University School of Medicine, Morgantown, WV, USA,
2Charleston Area Medical Center, Charleston, WV, USA.
BACKGROUND: Management of small suspicious lung nodules, located deep in the lung parenchyma, can present a clinically challenging scenario with options of continued surveillance, biopsy, or surgical intervention. Routine pre-operative tissue diagnosis is associated with significant use of resources, possible delays in care, morbidity, and the potential for false positive, false negative, and nondiagnostic results. We hypothesize that minimally invasive robotic pulmonary segmentectomy without pre-operative tissue biopsy is an acceptable diagnostic and therapeutic approach for small lung nodules deemed highly suspicious for malignancy by an experienced thoracic surgery team.
METHODS: We reviewed the outcomes of 70 consecutive robotic anatomic pulmonary segmentectomies performed in last 1.5 years using our institutional database. Descriptive statistics were summarized using Fisher’s exact test, and independent samples t-test for continuous variables. (Table 1)
RESULTS: A total of 58 robotic segmentectomies were performed without tissue diagnosis. Fourteen (24.1%) patients had intraoperative wedge resection with frozen section followed by completion segmentectomies. The remaining 44 (75.9%) patients had upfront robotic segmentectomies without pre-operative or intra-operative tissue confirmation; 39 of 44 (88.6%) lesions were malignant. Overall, among the entire cohort, 51 of 58 (87.9%) had malignant pathology, 50 (86.2%) had primary lung cancers, and one (1.7%) had a metastatic lesion. Seven (12.1%) patients had benign lesions which included caseating granulomas, post radiotherapy changes for remote lung nodule, and hamartoma.
CONCLUSIONS: Robotic pulmonary segmentectomy without tissue diagnosis for highly suspicious lung nodules is an acceptable minimally invasive diagnostic and curative option in high volume centers with nearly 90% diagnostic accuracy, similar to that of current tissue biopsy techniques, and low mortality. These results question the enthusiasm for routine biopsy of suspicious lung nodules detected incidentally or during lung cancer screening; they also highlight an alternative approach with a minimally invasive technique that avoids potential delays in care, unnecessary biopsies and their associated risks, and the threat of nondiagnostic or false results. Robotic-assisted segmentectomy enables both diagnostic and therapeutic interventions in a single minimally invasive procedure. Larger prospective studies are needed to validate these results.
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