Ability of single anesthesia for combined robotic-assisted bronchoscopy and surgical lobectomy to reduce time between detection and treatment in stage I non-small cell lung cancer

Adam J Wolf; Paige M Miller; John R Burk; Richard M Vigness; John W Hollingsworth

doi:10.1080/08998280.2023.2193134

Ability of single anesthesia for combined robotic-assisted bronchoscopy and surgical lobectomy to reduce time between detection and treatment in stage I non-small cell lung cancer

Proc (Bayl Univ Med Cent). 2023 Apr 7;36(4):434-438. doi: 10.1080/08998280.2023.2193134. eCollection 2023.

Authors

Adam J Wolf¹, Paige M Miller¹, John R Burk^{2

3

4}, Richard M Vigness⁵, John W Hollingsworth^{2

3

4}

Affiliations

¹ Texas Christian University Burnett School of Medicine, Fort Worth, Texas.
² Department of Medicine, Texas Christian University Burnett School of Medicine, Fort Worth, Texas.
³ Department of Pulmonology and Critical Care, Texas Health Harris Methodist Hospital, Fort Worth, Texas.
⁴ Texas Pulmonary and Critical Care Consultants LLC, Fort Worth, Texas.
⁵ Department of Thoracic Surgery, Texas Health Harris Methodist Hospital, Fort Worth, Texas.

Abstract

Background: Background: Early identification, diagnosis, and treatment of lung cancer is associated with improved clinical outcomes. Robotic-assisted bronchoscopy improves the ability to diagnose early stage lung malignancies and, when combined with robotic-assisted lobectomy under single anesthesia, could reduce time from identification to intervention in early stage lung cancer in a select patient population.

Methods: Methods: A retrospective case-control single-center study compared patients with radiographic stage I non-small cell carcinoma (NSCCA) undergoing robotic navigational bronchoscopy and surgical resection (N = 22) with historical controls (N = 63). The primary outcome was time from initial radiographic identification of a pulmonary nodule to therapeutic intervention. Secondary outcomes included times between identification to biopsy, biopsy to surgery, and procedural complications.

Results: Results: Patients with suspected stage I NSCCA who received single anesthesia for diagnosis and intervention with robotic-assisted bronchoscopy and robotic-assisted lobectomy had shorter times between identification of a pulmonary nodule and intervention compared to controls (65 vs 116 days, P = 0.005). Cases had lower rates of complications (0% vs 5%) and shorter hospitalizations after surgery (3.6 vs 6.2 days, P = 0.017).

Conclusion: Conclusion: Our findings support that implementing a multidisciplinary thoracic oncology team and single-anesthesia biopsy-to-surgery approach in management of stage I NSCCA significantly reduced times from identification to intervention, biopsy to intervention, and length of hospital stays in management of lung cancer.

Keywords: Bronchoscopy; lung cancer; malignancy; navigation; single anesthesia.