Robotic lobectomy ‘accepted’ technique for NSCLC
MedWire News: Robotic-based video-assisted thoracic surgery (VATS) lobectomy produces similar survival rates as conventional lobectomy when used in patients with non-small-cell lung cancer (NSCLC), report researchers.
However, cost, postoperative pain, and quality of life associated with robotic lobectomy will require investigation if this procedure is to achieve widespread adoption, say Bernard Park (Hackensack University Medical Center, New Jersey, USA) and team.
The researchers assessed perioperative outcomes and survival rates among 325 patients with NSCLC who underwent robotic lobectomy between November 2002 and May 2010, and were followed up for a median of 27 months.
The patients were aged 30-87 years (median 66 years), and were operated on in one of three centers in New York, USA (n=123), Milan, Italy (n=82), and Pisa, Italy (n=120).
In all, 51% of the lobectomies performed were on upper lobe tumors, and 73% of all tumors were adenocarcinomas. The majority of patients had stage IA disease (54%), with IB, IIA, IIB, and IIIA disease occurring in 22%, 13%, 5%, and 6% of patients, respectively.
As reported in the Journal of Thoracic and Cardiovascular Surgery, a median operative time of 3.5 hours was noted among the group.
Conversion to thoracotomy occurred in 8% of patients, and major complications, namely bronchopleural fistula, pulmonary embolism, acute renal insufficiency, hemorrhage, and myocardial infarction were observed among 3.7% of the group.
No intraoperative deaths occurred and one (0.3%) patient died after surgery. Overall morbidity occurred at a rate of 25.2%, and did not significantly differ between the three centers. Patients were discharged from hospital after a median inpatient stay lasting 5 days.
Park and team observed an overall 5-year survival rate of 80% among the group. When this outcome was assessed according to tumor stage, 5-year survival rates of 91%, 88%, 49%, and 43% were noted for patients with stage IA, IB, IIA or B, and IIIA disease, respectively.
These results, say the investigators, are similar to those seen with conventional nonrobotic VATS lobectomy.
They therefore conclude that robotic lobectomy "should not be considered experimental, but an accepted minimally invasive thoracic surgical technique."
They add: "Future evaluation of differences between robotic versus VATS versus thoracotomy approaches to thoracic diseases is warranted."
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By Lauretta Ihonor