PURPOSE: Lung cancer treatment often involves surgical procedures with accompanying morbidity. Certainly disruptive, such can also delay the initiation of chemo- or radiation therapy. Video assisted thoracic surgery (VATS) has been shown to lessen morbidity, facilitating earlier initiation of adjuvant therapies. Various issues, however, have limited these techniques to less than 20 percent of patients. Our objective was to evaluate daVinci robotic-assisted totally endoscopic surgery (dRATES) as a reproducible, broadly applicable, minimally invasive platform when surgical diagnosis, staging or resection of lung cancer is indicated.
METHODS: From 12/2009 to 3/2011 we prospectively evaluated 136 patients with lung cancer, undiagnosed intra-thoracic masses or thoracic adenopathy in known/recurrent lung cancer. Our surgical preference was dRATES, except where 1) a less invasive option existed, 2) no clear benefit over VATS existed or 3) patients could not tolerate the procedure.
RESULTS: 8 patients were inoperable. Thirty-four patients (25%) underwent traditional procedures; mediastinoscopy (22), open biopsy (7), or VATS procedure (5). Ninety-two patients (75%) underwent daVinci robotic assisted totally endoscopic procedures. 42 of 50 lobectomies (84%) were completed robotically with a mean length of stay (LOS) of 3.03d, a 2.3% transfusion rate and a 9.5% complication rate. Complications included air leak > 5d (2), pneumothorax (1) and atrial fibrillation (1). Non-lobectomy candidates underwent 21 sub-lobar resections with a mean LOS of 3.4d and complication rate of 4.8% (pneumonia). Lymph node dissection in 2 of these patients (10%), both PET negative, showed metastatic tumor, resulting in clinical upstaging. The 21 diagnostic/staging procedures were 100% successful in obtaining tissue, had a mean LOS of 1.6d and one complication. There were no mortalities.
CONCLUSIONS: This prospective, unselected series demonstrates that daVinci robotic assistance facilitates a reproducible, totally endoscopic surgical approach for use in the diagnosis, staging and treatment of lung cancer, with very compelling outcomes.
CLINICAL IMPLICATIONS: In contrast to VATS, these techniques, including curative resection, are applicable to a significant percentage of lung cancer patients. Additionally, low procedural morbidity allows surgical treatment of a greater number of non-lobectomy candidates. Oncologic information thus obtained can significantly alter clinical stage and subsequent treatment.
DISCLOSURE: The following authors have nothing to disclose: Doug Adams, Safdar Khan, Jewray Maheshwari
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