Abstract
BackgroundPatients with limited pulmonary function have a high risk for pulmonary complications following lobectomy. Robotic approach is currently the least invasive approach. We hypothesized that robotic lobectomy may be of particular benefit in high-risk patients.MethodsWe reviewed our institutional Society of Thoracic Surgeons (STS) data on lobectomy patients from 2012 to 2017. Postoperative outcomes were compared between robotic and open lobectomy groups. High-risk patients were identified by pulmonary function test. Risk of pulmonary complication was assessed by binary logistic regression analysis.ResultsA total of 599 patients underwent lobectomy by robotic (n = 287), or by open (n = 312) approach, including 189 high-risk patients. Robotic lobectomy patients had a lower rate of prolonged air leak (6% vs. 10%, p = 0.047), less atelectasis requiring bronchoscopy (6% vs. 16%, p = 0.02), pneumonia (3% vs. 8%, p = 0.01), and shorter length of stay (4 vs. 6 days, p = 0.001). Overall pulmonary complication rate was significantly lower after robotic lobectomy in high-risk patients (28% vs. 45%, p = 0.02), less in intermediate or low risk patients. No significant difference was seen relative to major complication rate (12% vs. 17%, p = 0.09). After multivariate analysis, when adjusting for age, gender, smoking history, FEV1, DLCO, cardiopulmonary comorbidities, and prior chest surgery, the robotic approach remained independently associated with decreased pulmonary complications (odds ratio 0.54, 95% confidence interval [0.34–0.85], p = 0.008).ConclusionsRobotic lobectomy has the potential to decrease the risk of postoperative pulmonary complication as compared with traditional open thoracotomy. In particular, patients with limited pulmonary function derive the most benefit from a robotic approach.
Highlights
Patients with limited pulmonary function have a high risk for pulmonary complications following lobectomy
Posterolateral open thoracotomy has been the traditional approach to pulmonary lobectomy, which is associated with significant morbidity and a decrease in functional reserve capacity (FRC)
Six patients who started with a robotic approach were converted to thoracotomy for limited visibility (n = 4) or restricted mobility (n = 2)
Summary
Patients with limited pulmonary function have a high risk for pulmonary complications following lobectomy. Robotic approach is currently the least invasive approach. We hypothesized that robotic lobectomy may be of particular benefit in high-risk patients. Posterolateral open thoracotomy has been the traditional approach to pulmonary lobectomy, which is associated with significant morbidity and a decrease in functional reserve capacity (FRC). Invasive techniques using video-assisted thoracoscopic surgery (VATS) and more recently robotic assisted lobectomy have been developed to enhance recovery by decreasing complications, shorten length of stay and improve quality of life [1, 2]. Robotic lobectomy uses a completely port based approach, which is currently the least invasive technology. The use of robotic lobectomy for lung cancer has tripled between 2010 and 2012 in the US from 3 to 9% [4]. In year 2015, more than 8600 pulmonary lobectomies have been performed robotically [5]
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