Marc Margolis, Farid Gharagozloo, Eric Strother, barbara Tempesta.
George Washington University Medical Center, Washington, DC, USA.
OBJECTIVE:
Video assisted lobectomy for lung cancer remains controversial. Controversies include technique, safety, and oncology efficacy. A totally endoscopic lobectomy without a “utility” thoracotomy has been difficult to accomplish. This has been in part due to the inherent shortcomings of conventional videoendoscopic instruments and the inability to perform fine dissection and complex 3-D maneuvers. Robotic surgical systems have the potential to overcome these shortcomings. We studied the use of the daVinci surgical robot for minimally invasive lobectomy in patients with early stage lung cancer.
METHODS:
In a 48 month period 57 patients (26 men, 31 women, mean age 66.2 yrs.) underwent a robotic lobectomy and complete mediastinal nodal dissection for early stage lung cancer (Stages I,II).
RESULTS:
Distribution of lobectomies was RUL14, RML 5, RLL 8, LUL 20, LLL 10. Operative times ranged from 3 to 6 hrs( median 4 hrs). There were 31 ACA, 14 SCCA, 6 Adenosquamous, 1 Large cell, 2 Bronchoalveolar, 2 poorly differentiated, 1 Carcinoid. Pathologic upstaging was noted in 10 patients (8 IIb, 2 IIIa). There were no emergent conversions to a thoracotomy. Complications included A fib (4), hydropneuothorax (1), atelectasis (4), prolonged air leak (2), pleural effusion (2). Mortality was 3.5%. Median hospitalization was 4 days. Followup was complete in 50 patients (87%). At a mean follow up of 28 months, all patients were alive,and 4 had distant metastases. There was no local recurrence.
CONCLUSIONS:
Robotic lobectomy for early stage lung cancer is feasible and may be associated with lower mediastinal recurrence when compared to VATS lobectomy. Greater experience and long term follow up is required to better evaluate patient selection, oncologic efficacy and comparability to a conventional approach.
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