Long-Term Oncologic Outcomes After Robotic Lobectomy for Early-stage Non-Small-cell Lung Cancer Versus Video-assisted Thoracoscopic and Open Thoracotomy Approach

Peter J Kneuertz; Desmond M D'Souza; Morgan Richardson; Mahmoud Abdel-Rasoul; Susan D Moffatt-Bruce; Robert E Merritt

doi:10.1016/j.cllc.2019.10.004

Long-Term Oncologic Outcomes After Robotic Lobectomy for Early-stage Non-Small-cell Lung Cancer Versus Video-assisted Thoracoscopic and Open Thoracotomy Approach

Clin Lung Cancer. 2020 May;21(3):214-224.e2. doi: 10.1016/j.cllc.2019.10.004. Epub 2019 Oct 13.

Authors

Peter J Kneuertz¹, Desmond M D'Souza², Morgan Richardson², Mahmoud Abdel-Rasoul³, Susan D Moffatt-Bruce², Robert E Merritt²

Affiliations

¹ Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: Peter.Kneuertz@osumc.edu.
² Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
³ Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH.

PMID: 31685354
DOI: 10.1016/j.cllc.2019.10.004

Abstract

Background: Although robotic-assisted lobectomy has been increasingly used for resection of non-small-cell lung cancer (NSCLC), the long-term oncologic outcomes compared with video-assisted thoracoscopic surgery (VATS) and the open thoracotomy approach have remained ill-defined.

Patients and methods: Society of Thoracic Surgeons outcomes data and surveillance records of patients with stage I-IIIa NSCLC who had undergone lobectomy by robotic-assisted, VATS, or the open approach at a single center from 2012 to 2017 were reviewed. Propensity score adjustment by inverse probability of treatment weighting was used to balance the baseline characteristics. Recurrence and survival were analyzed and compared by the operative approach.

Results: The inverse probability of treatment weighting-adjusted cohort included 514 patients with NSCLC who had undergone robotic-assisted (n = 245), VATS (n = 118), and open (n = 151) lobectomy, with similar patient and disease characteristics. The minimally invasive procedures were associated with a shorter median hospital length of stay (robotic, 5.2 days; VATS, 4.9 days; open, 7.3 days; P < .001) and 0-adjusted 30-day mortality rate. With a median follow-up period of 45 months, the incidence for locoregional recurrence (robotic, 7%; VATS, 6%; open, 8%; P = .9) and distant failure (robotic, 14%; VATS, 18%; open, 17%; P = .9) was similar. The 5-year overall survival for robotic-assisted, VATS, and open lobectomy was 63%, 55%, and 65%, respectively (P = .56). No difference was found in stage-specific survival for stage I, II, and IIIa. On multivariate analysis, the robotic approach was associated with no differences in overall survival and recurrence-free survival compared with VATS and open lobectomy.

Conclusion: Robotic lobectomy was associated with durable freedom of recurrence and long-term survival equivalent to those achieved with VATS and the traditional open thoracotomy approach.

Keywords: Lobectomy; Long-term outcomes; Non-small cell lung cancer; Robotic; VATS.

Publication types

Comparative Study

MeSH terms

Aged
Carcinoma, Non-Small-Cell Lung / mortality*
Carcinoma, Non-Small-Cell Lung / pathology
Carcinoma, Non-Small-Cell Lung / surgery
Female
Follow-Up Studies
Humans
Lung Neoplasms / mortality*
Lung Neoplasms / pathology
Lung Neoplasms / surgery
Male
Middle Aged
Pneumonectomy / mortality*
Prognosis
Retrospective Studies
Robotic Surgical Procedures / mortality*
Thoracic Surgery, Video-Assisted / mortality*
Thoracotomy / mortality*