Abstract
Despite there already being many studies on robotic surgery as a minimally invasive approach for non-small-cell lung cancer (NSCLC) patients, the use of this technique for stage III disease is still poorly described. These are the preliminary results of our prospective study on the safety and effectiveness of robotic approaches in patients with locally advanced NSCLC in terms of postoperative complications and oncological outcomes. Since 2016, we prospectively investigated 19 consecutive patients with NSCLC stage IIIA-pN2 (diagnosed by EBUS-TBNA) who underwent lobectomy and radical lymph node dissection with robotic approaches after induction treatment. Furthermore, we matched a case-control study with 46 patients treated with open surgery during the same period of time, with similar age, comorbidities, clinical stage and tumor size. The individual matched population was composed of 16 robot-assisted thoracic surgeries and 16 patients who underwent open surgery. The median time range of resection was inferior in the open group compared to robotic lobectomy (243 vs. 161 min; p < 0.001). Lymph node resection and positivity were not significantly different (p = 0.96 and p = 0.57, respectively). Moreover, no difference was observed for PFS (p = 0.16) or OS (p = 0.41). In conclusion, we demonstrated that the early outcomes and oncological results of N2-patients after robotic lobectomy were similar to those who had open surgery. Considering the advantages of minimally invasive surgery, robot-assisted lobectomy appears to be a safe approach to patients with locally advanced diseases.
Highlights
Lung cancer represents the most frequent cause of death from malignancy worldwide, with non-small-cell lung cancer (NSCLC) as the most frequently presented type of epithelial lung cancer [1]
We present our preliminary results on the prospective evaluation of the safety and effectiveness of robot-assisted lobectomy in pN2-NSCLC patients after induction therapy (IT)
Patients were subjected to IT: 17 (89.5%) underwent platinum-based chemotherapy, and 2 (10.5%) patients underwent only target therapy (one with Afatinib and one with Nivolumab, considering Epidermal growth factor receptor (EGFR) mutation)
Summary
Lung cancer represents the most frequent cause of death from malignancy worldwide, with non-small-cell lung cancer (NSCLC) as the most frequently presented type of epithelial lung cancer [1]. 10% of new diagnoses are patients with stage IIIA disease, with a mediastinal ipsilateral lymph node involvement (N2) In select cases, these patients may be candidates for surgery; considering the heterogeneity of patients, multimodality approach should always be considered. We have shown that patients that are candidates for surgery after IT had a five-year OS that was significantly higher than those who underwent exploratory thoracotomy or incomplete resection (35% vs 8% at five years, respectively). This underlines the importance of surgical resection of the residual disease in select patients [3]
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