SESSION TITLE: Thoracic Surgery
SESSION TYPE: Slide Presentations
PRESENTED ON: Saturday, March 22, 2014 at 09:00 AM - 10:00 AM
PURPOSE: We investigated whether robotic-assisted video-thoracoscopic surgery improves lymph node (LN) dissection and LN metastasis detection.
METHODS: We retrospectively analyzed all patients who underwent robotic-assisted lobectomy for non-small cell lung cancer (NSCLC) by one surgeon over 34 months. Clinical stage was determined by computerized tomography, positron-emission tomography, brain imaging studies, and endobronchial ultrasonography. Pathologic stage was based on final pathology. Tumor histology, the numbers of all LN stations and of all individual LNs analyzed and their locations, and the numbers of mediastinal (N2) LN stations and of individual N2 LNs and their locations were noted. Changes from clinical stage to pathologic stage were noted
RESULTS: Of 159 patients (mean age 67.6+/-0.8yr; range 39-86yr), mean tumor size was 3.3+/-0.2cm (range 0.8-11.0cm), most commonly adenocarcinoma (63.5%), squamous cell carcinoma (20.8%), and neuroendocrine carcinoma (8.2%). Assessment of >3 N2 stations occurred in 156 (98.1%) patients, with 141 (88.7%) having >3 N2 stations reported. Mean total LN stations assessed was 5.6+/-0.1 stations; mean N2 stations assessed was 4.1+/-0.1 stations. Mean total LNs reported was 13.4+/-0.5 LNs; mean N2 LNs reported was 7.2+/-0.3 LNs. There were 118 (74.2%) patients who were clinical stage I versus 96 (60.4%) who were pathologic stage I, with 49 (30.8%) patients upstaged (including 13 patients from N0 to N1, 13 patients from N0 to N2, and 4 patients from N1 to N2) and 20 (12.6%) downstaged. In comparison: D’Amico et al (Ann Thor Surg 2011;92:226) reported 66% of video-assisted thoracoscopic (VATS) lobectomies and 58% of open lobectomies assessed >3 N2 stations, with 8.8% upstaged by VATS and 14.5% by thoracotomy; Watanabe et al (Surgery 2005;138:510) reported highest upstaging of 20.1% by VATS and 30.3% by thoracotomy; and Park et al (J Thorac Cardiovasc Surg 2012;143:383) reported 21% upstaging for robotic lobectomy.
CONCLUSIONS: Mediastinal LN dissection during robotic-assisted lobectomy results in more LN stations and more LNs assessed and greater upstaging than during VATS or thoracotomy.
CLINICAL IMPLICATIONS: Upstaging translates to more adjuvant treatment, which translates to fewer recurrence and improved survival.
DISCLOSURE: Eric Toloza: Other: Honoraria for proctoring & observation site The following authors have nothing to disclose: Frank Velez-Cubian, Wei Wei Zhang, Kathryn Rodriguez, Matthew Thau, Carla Moodie, Joseph Garrett, Jacques-Pierre Fontaine, Lary Robinson
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