Robotic-assisted Pulmonary Lobectomy Research Articles

Marital Status Shows No Protective Effect on Perioperative Outcomes after Robotic-Assisted Pulmonary Lobectomy

Marital Status Shows No Protective Effect on Perioperative Outcomes after Robotic-Assisted Pulmonary Lobectomy

122P Evaluating the predictive accuracy of the Lee Revised Cardiac Risk Index for postoperative complications and survival after robotic-assisted pulmonary lobectomy

122P Evaluating the predictive accuracy of the Lee Revised Cardiac Risk Index for postoperative complications and survival after robotic-assisted pulmonary lobectomy

A High Preoperative Blood Urea Nitrogen to Serum Albumin Ratio Does Not Predict Worse Outcomes Following the Robotic-Assisted Pulmonary Lobectomy for Lung Cancer.

The blood urea nitrogen to serum albumin ratio (BAR) is an emerging prognostic parameter of interest.The utility of BAR as a prognostic factor has not been analyzed in lung cancer patients undergoing pulmonary lobectomy.We evaluated the ability of High BAR to predict worse outcomes after robotic-assisted pulmonary lobectomy (RAPL) for lung cancer. We retrospectively analyzed 400 patients who underwent RAPL from September 2010 to March 2022 by one surgeon. Patients were stratified by Low BAR (<6.25 mg/g) and High BAR (≥6.25 mg/g).Patients' demographics, tumor characteristics, comorbidities, surgical complications, outcomes, and survival were collected and compared by High and Low BAR groups.The primary outcome of interest was 30-day mortality. Receiver operator curves (ROC) confirmed that 6.25 was an optimal threshold for estimating mortality based on Low and High BAR.There were no differences in surgical complications or outcomes between the Low and High BAR groups.The ability of BAR to predict 30-day mortality was evaluated with the area under the curve (AUC) analysis, which showed that higher BAR could not predict mortality (AUC=0.655; 95% CI, 0.435-0.875; p=0.166).Similarly, survival analysis revealed no difference in five-year overall survival between the Low and High BAR groups (p=0.079). High BAR did not predict worse outcomes after RAPL for lung cancer in our study.Further studies are needed to better determine the prognostic ability of BAR in lower-risk populations.

EP07.03-11 Effects of Intraoperative Trainees on Outcomes after Robotic-Assisted Pulmonary Lobectomy

EP07.03-11 Effects of Intraoperative Trainees on Outcomes after Robotic-Assisted Pulmonary Lobectomy

Residential Distance to the Cancer Center and Outcomes after Robotic-Assisted Pulmonary Lobectomy

Residential Distance to the Cancer Center and Outcomes after Robotic-Assisted Pulmonary Lobectomy

Changes in Perioperative Outcomes after Robotic-Assisted Pulmonary Lobectomy during the COVID-19 Era

The COVID-19 pandemic presented patients with barriers to receiving healthcare. We sought to determine whether changes in healthcare access and practice during the pandemic affected perioperative outcomes after robotic-assisted pulmonary lobectomy (RAPL). We retrospectively analyzed 721 consecutive patients who underwent RAPL. With March 1st, 2020, defining the start of the COVID-19 pandemic, we grouped 638 patients as "PreCOVID-19" and 83 patients as "COVID-19-Era" based on surgical date. Demographics, comorbidities, tumor characteristics, intraoperative complications, morbidity, and mortality were analyzed. Variables were compared utilizing Student's t-test, Wilcoxon rank-sum test, and Chi-square (or Fisher's exact) test, with significance at p Multivariable generalized linear regression was used to investigate predictors of postoperative complication. COVID-19-Era patients had significantly higher preoperative FEV1%, lower cumulative smoking history and higher incidences of preoperative atrial fibrillation, peripheral vascular disease (PVD), and bleeding disorders compared to PreCOVID-19 patients. COVID-19-Era patients had lower intraoperative estimated blood loss (EBL), reduced incidence of new-onset postoperative atrial fibrillation (POAF), but higher incidence of effusion or empyema postoperatively. Overall postoperative complication rates between the groups were similar. Older age, increased EBL, lower preoperative FEV1%, and preoperative COPD are all predictive of an increased risk for postoperative complication. COVID-19-Era patients having lower EBL and less new-onset POAF, despite greater incidences of multiple preoperative comorbidities, demonstrates that RAPL is safe during the COVID-19 era. Risk factors for development of postoperative effusion should be determined to minimize risk of empyema in COVID-19-Era patients. Age, preoperative FEV1%, COPD, and EBL should all be considered when planning for complication risk.

100P Effects of U.S. insurance type on 5-year all-cause mortality after robotic-assisted pulmonary lobectomy for lung cancer

100P Effects of U.S. insurance type on 5-year all-cause mortality after robotic-assisted pulmonary lobectomy for lung cancer

Effect of octogenarian status on outcomes after robotic-assisted pulmonary lobectomy for primary lung cancer

Effect of octogenarian status on outcomes after robotic-assisted pulmonary lobectomy for primary lung cancer

Effects of preoperative pulmonary function on perioperative outcomes after robotic-assisted pulmonary lobectomy

IntroductionEffects of pulmonary function test (PFT) results on perioperative outcomes were investigated after robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy. MethodsWe retrospectively analyzed 706 consecutive patients who underwent RAVT lobectomy by one surgeon over 10.8 years. Preoperative (preop) forced expiratory volume in 1 s as a percent of predicted (FEV1%) was used to group patients as having normal FEV1% (≥80%) versus reduced FEV1% (<80%). Demographics, preop comorbidities, intraoperative (intraop) and postoperative (postop) complications, perioperative outcomes, and median survival time (MST) were compared across patients with normal vs. reduced FEV1% using Chi-Square (X2), Fisher's Exact test, Student's t-test, Kruskal-Wallis test, or Kaplan-Meier analysis respectively, with significance at p ≤ 0.05. Multivariable analysis was performed for perioperative outcomes to investigate the differences across patients in the FEV1% groups. ResultsThere were 470 patients with normal FEV1% and 236 patients with reduced FEV1%. The two FEV1% groups did not differ in intraop or postop complication rates, except for higher postop other arrhythmia requiring intervention (p = 0.004), prolonged air leak >5 days (p = 0.002), mucous plug formation (p = 0.009), hypoxia (p < 0.001), and pneumonia (p = 0.002), and total postop complications (p < 0.001) in reduced-FEV1% patients. Reduced FEV1% correlated with increased intraop estimated blood loss (p < 0.0001) and skin-to-skin operative time (p < 0.0001). Median overall survival in patients with normal FEV1% was 93.20 months (95% CI: 76.5–126.0) versus 58.9 months (95% CI: 50.4–68.4) in patients with reduced FEV1% (p = 0.0004). ConclusionPatients should have PFTs conducted before surgery to determine at-risk patients. However, RAVT pulmonary lobectomy is feasible and safe even in patients with reduced FEV1%.

New-onset postoperative atrial fibrillation is associated with perioperative inflammatory response and longer hospital stay after robotic-assisted pulmonary lobectomy

New-onset postoperative atrial fibrillation is associated with perioperative inflammatory response and longer hospital stay after robotic-assisted pulmonary lobectomy

PP.30 Comparing the Most Influential Publications on Robotic-Assisted Pulmonary Lobectomy and on Robotic-Assisted Pulmonary Segmentectomy

PP.30 Comparing the Most Influential Publications on Robotic-Assisted Pulmonary Lobectomy and on Robotic-Assisted Pulmonary Segmentectomy

PP.34 Impact of Cardiac Comorbidities on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy

PP.34 Impact of Cardiac Comorbidities on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy

PP.32 Postoperative Serum Magnesium Levels and Outcomes Following Robotic-Assisted Pulmonary Lobectomy

PP.32 Postoperative Serum Magnesium Levels and Outcomes Following Robotic-Assisted Pulmonary Lobectomy

Effect of Surgical Day of Week on Postoperative Outcomes After Robotic-Assisted Pulmonary Lobectomy.

Introduction Patients who have surgery late in the week could potentially receive different postoperative care due to a reduced weekend staff compared to patients who have surgery early in the week, who willbecared for by a full staff during the work week.Our aim was to determine if patients who underwent robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy during the first half of the week had different outcomes than patients who also underwent RAVT pulmonary lobectomy during the second half of the week. Methods We analyzed 344 consecutive patients who underwent RAVT pulmonary lobectomy by one surgeon from 2010 to 2016.Depending on the day of the surgical procedure, these patients were either put into a Monday through Wednesday (M-W) group or a Thursday through Friday (Th-F) group.Patient demographics, tumor histopathology, intraoperative and postoperative complications, and perioperative outcomes were compared between groups using the Student's t-test, Kruskal-Wallis test, or chi-square (or Fisher's exact) test, with p≤0.05 as significant. Results There were more non-small cell lung cancers (NSCLCs) resected in the M-W group than in the Th-F group (p=0.005).Skin-to-skin and total operative times were greater for the Th-F group than for the M-W group (p=0.027 andp=0.017, respectively).There were no significant differences in any other variables assessed. Conclusions Our study showed that, despite reduced weekend staffing and potential differences in postoperative care, there were no significant differences seen in postoperative complications or perioperative outcomes based on surgical day of the week.

The Presence of a Cost-Volume Relationship in Robotic-assisted Thoracoscopic Lung Resections.

To characterize the relationship between institutional robotic-assisted pulmonary lobectomy volume and hospitalization costs. The high cost of robotic-assisted thoracoscopic surgery (RATS) is among several drivers of hesitation among nonadopters. Studies examining the impact of institutional experience on costs of RATS lobectomy are lacking. Adults undergoing RATS lobectomy for primary lung cancers were identified from the 2016 to 2018 Nationwide Readmissions Database. A multivariable regression to model hospitalization costs was developed with the inclusion of hospital RATS lobectomy volume as restricted cubic splines. The volume corresponding to the inflection point of the spline was used to categorize hospitals as high- (HVH) or low-volume (LVH). We subsequently examined the association of HVH status with adverse events, length of stay, costs, and 30-day, nonelective readmissions. An estimated 14,756 patients underwent RATS lobectomy during the study period, with median cost of $23,000. Upon adjustment for patient and operative characteristics, hospital RATS volume was inversely associated with costs. Although only 17.2% of centers were defined as HVH, 51.7% of patients were managed at these centers. Patients at HVH and LVH had similar age, sex, and distribution of comorbidities. Notably, patients at HVH had decreased risk-adjusted odds of adverse events (adjusted odds ratio: 0.62, P <0.001), as well as significantly reduced length of stay (-0.8d, P <0.001) and costs (-$3900, P <0.001). Increasing hospital RATS lobectomy volume was associated with reduced hospitalization costs. Our findings suggest the presence of streamlined care pathways at high-volume centers, which influence costs of care.

EP02.03-005 Perioperative Factors That Predict or Are Associated With Prolonged Air Leaks After Robotic-Assisted Pulmonary Lobectomy

Prolonged air leaks (PAL) lasting longer than 5 days after pulmonary resection complicate the postoperative course, prolong hospital lengths of stay (LOS), and increase costs. We analyzed pre- and peri-operative factors and postoperative (postop) complications associated with PAL in patients who underwent robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy.

Robotic-assisted pulmonary lobectomy with lung cancer in a patient with situs inversus totalis

BackgroundSitus inversus totalis (SIT) is a relatively rare congenital abnormality in which the major thoracic and abdominal visceral organs are reversed from their usual positions. In patients with SIT and bronchial carcinoma, surgical difficulty increases sharply. It has been reported that the video-assisted thoracic surgery (VATS) still poses the operator to a challenge situation. The similarity of surgical positions and the flexibility of the mechanical arm in robotic surgery, may be beneficial to SIT patients due to reducing technical difficulties. Here, we present a first case of SIT patient with lung cancer, in which Da Vinci robot-assisted thoracic surgery (RATS) was performed successfully.Case presentationA 66-year old patient, previously diagnosed with SIT since childhood, came to our hospital with two pulmonary nodules in his left lung field. The bigger one had increased somewhat for the last 2 years of follow-up. Software Mimics was preoperatively carried out to analyze anatomical variations. RATS was conducted to complete left upper lobectomy and left middle wedge resection. The patient had no intraoperative complications and was discharged day 5 after the operation.ConclusionsThis is the first report of a successful robot-assisted lung cancer resection in a patient with SIT. In such challenging cases as lung cancer and rare anomaly as SIT, RATS is more advantageous and suitable than VATS with the help of software Mimics utilized for 3D reconstruction, which can identify the anatomical abnormalities and facilitate the surgical procedures.

Self-assisting robot-assisted pulmonary lobectomy has favorable outcome compared to VATS lobectomy.

BackgroundOpen and video-assisted thoracoscopic surgery (VATS) pulmonary lobectomy requires a skilled assistant to complete the operation. A potential benefit of a robot is to allow a surgeon to complete the operation autonomously. We sought to determine the safety of performing robotic-assisted pulmonary lobectomy with self-assistance.MethodsWe performed a retrospective analysis of self-assisting robot-assisted lobectomy. We evaluated the intraoperative and postoperative outcomes. We compared the outcome to the propensity matched group of patients who had VATS lobectomy. We also compared them to published outcomes of robot-assisted lobectomy.Results95 patients underwent self-assisted lobectomies. The median age was 70 years old, predominately female (57%) and white (85%) with 90% of patients undergoing surgery for cancer. The median of estimated blood loss was 25 mL during the operation with no conversions to open thoracotomies. After the operation, 17% of patients had major postoperative complications with a median length of stay of 2 days. At thirty-day follow-up, the readmission rate was 6.5%, with a mortality of 0%. Compared to the propensity matched VATS lobectomy group, there was significantly less conversion to open surgery (n=0, 0% vs. n=10, 12.2%, P=0.002), less intraoperative blood transfusions (n=0, 0% vs. n=6, 7.3%, P=0.03), less any complications (n=20, 24.4% vs. n=41, 50%, P=0.003), and less median length of stay (2 days, IQR 2, 5 days vs. 4 day, IQR 3, 6 days, P<0.001) in the self-assisting robot lobectomy group. Compared to published outcomes of robot-assisted lobectomy, our series had significantly fewer conversions to open (P=0.03), shorter length of stay (P<0.001), more discharges to home (93.7%) without a difference in procedure time (P=0.38), overall complication rates (P=0.16) and mortality (P=0.62).ConclusionsSelf-assistance using the robot technology during pulmonary lobectomy had few technical complications and acceptable morbidity, length of stay, and mortality. This group had favorable outcome compared to VATS lobectomy. The ability to self-assist during pulmonary lobectomy is an additional benefit of the robot technology compared to open and VATS lobectomy.

Distance of Residence From the Cancer Center Influences Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy?

IntroductionIncreased distance of residence from the hospital has been previously associated with worse postoperative outcomes, especially increased hospital length of stay (LOS) after elective surgery in the USA as well as after pulmonary lobectomy in Japan. We sought to determine if the distance from our cancer center affects postoperative outcomes after robotic-assisted pulmonary lobectomy.MethodsWe retrospectively analyzed 449 patients who underwent robotic-assisted pulmonary lobectomy by one surgeon for known or suspected lung cancer. Two patients were excluded due to incomplete data. Each patient’s residential ZIP code was used to determine the distance of their primary residence from our cancer center. Group 1 consisted of patients living less than 120 miles away while Group 2 consisted of patients living more than 120 miles away. Demographic factors, preoperative comorbidities, the incidence of postoperative complications, chest tube duration, and hospital LOS were compared by the Pearson chi-square or Kruskal-Wallis tests, and Kaplan-Meier survival was compared by Cox regression. Statistical significance was established as p≤0.05.ResultsGroup 1 was found to have a higher mean body mass index (BMI) (28.3 kg/m2) than Group 2 (27.0 kg/m2; p=.031). Group 1 also tended to have a higher rate of preoperative hypertension (HTN; 59%) than Group 2 (47%; p=.018). No other preoperative comorbidities were significant. Median hospital LOS was found to differ between Group 1 (4 days) and Group 2 (5 days; p=.048). Postoperative complication rates did not differ between Group 1 (35%) and Group 2 (40%; p=.370). Median chest tube durations for Group 1 (4 days) vs. Group 2 (4 days) did not differ (p=.093). Five-year overall survival (OS) did not differ between the two groups (p=.550).ConclusionsLonger distance from patient residence to our cancer center was associated with higher BMI, higher rates of preoperative HTN, and longer LOS. Postoperative complication rates, chest tube duration, and five-year OS were not significantly affected by distance. These results supported similar results in a Japanese study that indicated distance extends the LOS, regardless of the type of transportation used by patients. Further research analyzing the effects of socioeconomic status and insurance coverage on perioperative outcomes should be conducted to identify subpopulations in the USA that suffer disparities in access to and delivery of healthcare.

Effect of Socio-Economic Status on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy

Background: Lower socioeconomic status (SES) has been correlated with poor survival rates and surgical outcomes following lung cancer resection. This study sought to determine whether this disparity exists perioperatively in lung cancer patients following robotic-assisted video-thoracoscopic pulmonary lobectomy. Methods: We retrospectively reviewed 447 consecutive patients who underwent robotic-assisted pulmonary lobectomy by one surgeon for known or suspected lung cancer. Ten patients were excluded due to incomplete data. We used median income by residential ZIP code as a surrogate for SES status and grouped patients based on whether ZIP-based median income was less than (Group 1) or greater than (Group 2) 300% of the federal poverty income level. The effects of SES status groups on incidence of postoperative complications, chest tube duration, hospital length of stay (LOS), and in-hospital mortality were evaluated by the logistic regression model and Inverse Gaussian regression model, respectively.Results: Without adjustment, Group 1 tended to have a higher rate of postoperative complications, with 54% of patients experiencing complications compared to 34% of patients in Group 2 (p=0.007). Median chest tube duration and hospital LOS were also significantly longer in Group 1 than in Group 2 (p=0.034). In multivariable logistical regression analysis, while controlling for covariates and considering effect modifications, lower SES was significantly and positively associated with postoperative complications (odds ratio (OR)=1.98, p=0.039). Preoperative chronic obstructive pulmonary disease (COPD) was also a positive and significant predictor of postoperative complications (OR=1.89, p=0.017), chest tube duration (p=0.020), and LOS (p=0.010).Conclusions: Lower median income is associated with a greater number of postoperative complications following pulmonary resection for lung cancer when controlling for covariates.