Robotic Approach Offers Similar Nodal Upstaging to Open Lobectomy for Clinical Stage I Non-small Cell Lung Cancer

Abstract

Appropriate nodal dissection during pulmonary resection improves pathologic staging accuracy. Detection of unexpected nodal metastases can be a surrogate for nodal dissection adequacy and reflect oncologic resection quality. The goal of this study was to determine whether robotic lobectomy carries worse, same, or better incidence of nodal upstaging as open lobectomy for clinical stage I non-small cell lung cancer (NSCLC). Data for patients with clinical stage I NSCLC (≤cT2a N0 M0, American Joint Committee on Cancer, 7th Edition) who underwent lobectomy from 2010 through 2015 were abstracted from the National Cancer Database (NCDB). Propensity score matching was performed for robotic (n= 7452) and open (n= 50,186) approaches. Primary outcomes were the number of lymph nodes examined and incidence of nodal upstaging, defined as unexpected hilar or mediastinal lymph node involvement. Secondary outcomes included resection margins and overall survival. Matching generated 7452 well-matched pairs. There were no differences in nodal upstaging between robotic and open procedures (820 [11.0%] vs 863 [11.6%], P= .28), despite more examined lymph nodes in the robotic group (10 vs 8, P < .001). Incidence of positive margins (145 [2.0%] vs 178 [2.4%], P= .071) was similar. The robotic group had lower 30-day (73 [1.3%] vs 105 [1.9%], P= .02) and 90-day mortality (125 [2.3%] vs 188 [3.5%], P < .001). The 5-year overall survival was similar between both groups (65.6% vs 66.7%, log-rank P= .25). Robotic lobectomy for clinical stage I NSCLC is an equivalent to open lobectomy as assessed by similar nodal upstaging rates, completeness of resection, and overall survival. This suggests that the robotic technology has been adopted appropriately in early-stage NSCLC.