Perioperative outcome of robot-assisted pulmonary lobectomy in treating 333 patients with pathological stage Ⅰ non-small cell lung cancer: A single center report_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Jiantao ^1,2 , HUANG Jia ^1,2 , LIN Hao ¹ ,  LUO Qingquan ^1,2

1. Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, P.R.China;
2. School of Medicine, Jiangsu University, Zhenjiang, 212013, Jiangsu, P.R.China;

Corresponding author：

LUO Qingquan, Email: Luoqingquan@hotmail.com

Keywords：

da Vinci; robot-assisted thoracoscopic surgery; pulmonary lobectomy; non-small cell lung cancer; perioperative outcome; cost

DOI：

10.7507/1007-4848.201707028

Video：

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Objective To investigate the perioperative outcome of robot-assisted pulmonary lobectomy in treating pathological stage Ⅰ non-small cell lung cancer (NSCLC). Methods We retrospectively analyzed the clinical data of 333 consecutive p-T1 NSCLC patients who underwent robotic-assisted pulmonary lobectomy in our hospital between May 2013 and April 2016. There were 231 females (69.4%) and 102 males (30.6%) aged from 20–76 (55.01±10.46) years. Cancer was located in the left upper lobectomy in 37 (11.1%) patients, left lower lobectomy in 71 (21.3%) patients, right upper lobectomy in 105 (31.5%) patients, right middle lobectomy in 32 (9.6%) patients, right lower lobectomy in 88 (26.4%) patients. Adenocarcinoma was confirmed in 330 (99.1%) patients and squamous cell cancer was confirmed in 3 (0.9%) patients. Results Total operative time was 46–300 (91.51±30.80) min. Estimated intraoperative blood loss was 0–100 ml in 319 patients (95.8%), 101–400 ml in 12 patients (3.6%), >400 ml in 2 patients (0.6%). Four patients were converted to thoracotomy, including 2 patients due to pulmonary artery branch bleeding and 2 due to pleural adhesion.No patient died within 30 days after surgery. And no perioperative blood transfusion occurred. Postoperative day 1 drain was 0–960 (231.39±141.87) ml. Chest drain time was 2–12 (3.96±1.52) d.And no patient was discharged with chest tube. Length of hospital stay after surgery was 2–12 (4.96±1.51) d. Persistent air leak was in 12 patients over 7 days. No readmission happened within 30 days. All patients underwent lymph node sampling or dissection with 2–9 (5.69±1.46) groups and 3–21 (9.80±3.43) lymph nodes harvested. Total intraoperative cost was 60 389.66–134 401.65 (93 809.23±13 371.26) yuan. Conclusion Robot-assisted pulmonary lobectomy is safe and effective in treating p-Stage Ⅰ NSCLC, and could be an important supplement to conventional VATS. Regarding to cost, it is relatively more expensive compared with conventional VATS. RATS will be widely used and make a great change in pulmonary surgery with the progressive development of surgical robot.

Citation： LI Jiantao, HUANG Jia, LIN Hao, LUO Qingquan. Perioperative outcome of robot-assisted pulmonary lobectomy in treating 333 patients with pathological stage Ⅰ non-small cell lung cancer: A single center report. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(11): 825-829. doi: 10.7507/1007-4848.201707028 Copy

1.	林皓, 黄佳, 谭强,等. 机器人辅助胸腔镜左肺下叶切除两例. 中华腔镜外科杂志:电子版, 2012, 5(4): 28-31.
2.	Melfi FMA, Menconi GF, Mariani AM, et al. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg, 2002, 21(5): 864.
3.	罗清泉, 林皓, 黄佳, 等. 机器人辅助胸腔镜肺叶切除 12 例临床分析. 中国胸心血管外科临床杂志, 2014, 21(1): 25-28.
4.	Lacroix V, Nezhad ZM, Kahn D, et al. Pain, quality of life, and clinical outcomes after robotic lobectomy. Thorac Cardiovasc Surg, 2017, 65(5): 344-350.
5.	Velez-Cubian FO, Rodriguez KL, Thau MR, et al. Efficacy of lymph node dissection during robotic-assisted lobectomy for non-small cell lung cancer: retrospective review of 159 consecutive cases. Chest, 2014, 145(3):2454-2463.
6.	Lee BE, Shapiro M, Rutledge JR, et al. Nodal upstaging in robotic and video assisted thoracic surgery lobectomy for clinical N0 lung cancer. Ann Thorac Surg, 2015, 100(1): 229-234.
7.	Park BJ. Robotic lobectomy for non-small cell lung cancer: long-term oncologic results. J Thorac Cardiovasc Surg, 2014, 24(2): 383-389.
8.	Park BJ. Robotic lobectomy for non-small cell lung cancer (NSCLC): Multi-center registry study of long-term oncologic results. Ann Cardiothorac Surg, 2012, 1(1): 24.
9.	Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stage Ⅰ non-small cell lung cancer: comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265(2):431-437.
10.	Agzarian J, Fahim C, Shargall Y, et al. The use of robotic-assisted thoracic surgery for lung resection: A comprehensive systematic review. Semin Thorac Cardiovasc Surg, 2016, 28(1): 182-192.
11.	Liang H, Liang W, Zhao L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: a meta-analysis. Ann Surg, 2017 Jun 16. doi: 10.1097/SLA.0000000000002346. [Epub ahead of print].
12.	Meyer M, Gharagozloo F, Tempesta B, et al. The learning curve of robotic lobectomy. Int J Med Robot, 2012, 8(4): 448-452.
13.	Kent M, Wang T, Whyte R, et al. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg, 2014, 97(1): 242-244.
14.	Rajaram R, Mohanty S, Bentrem DJ, et al. Nationwide assessment of robotic lobectomy for non-small cell lung cancer. Ann Thorac Surg, 2017, 103(4): 1092-1100.
15.	Nakamura H. Systematic review of published studies on safety and efficacy of thoracoscopic and robot-assisted lobectomy for lung cancer. Ann Thorac Cardiovasc Surg, 2014, 20(2): 93-98.
16.	Toker A, Özyurtkan MO, Kaba E, et al. Robotic anatomic lung resections: the initial experience and description of learning in 102 cases. Surg Endosc, 2016, 30(2): 676-683.
17.	Montane B, Toosi K, Velez-Cubian FO, et al. Effect of obesity on perioperative outcomes after robotic-assisted pulmonary lobectomy. Surg Innov, 2017, 24(2): 122-132.
18.	Echavarria MF, Cheng AM, Velez-Cubian FO, et al. Comparison of pulmonary function tests and perioperative outcomes after robotic-assisted pulmonary lobectomy vs segmentectomy. Am J Surg, 2016, 212(6): 1175-1182.
19.	Bao F, Zhang C, Yang Y, et al. Comparison of robotic and video-assisted thoracic surgery for lung cancer: a propensity-matched analysis. J Thorac Dis, 2016, 8(7): 1798-1803.
20.	Lazar JF, Spier LN, Hartman AR, et al. Standardizing robotic lobectomy: feasibility and safety in 128 consecutive lobectomies within a single healthcare system. Innovations (Phila), 2017, 12(2): 77-81.
21.	Fahim C, Hanna W, Waddell T, et al. Robotic-assisted thoracoscopic surgery for lung resection: the first Canadian series. Can J Surg, 2017, 60(4): 5316.
22.	Schmid T, Augustin F, Kainz G, et al. Hybrid video-assisted thoracic surgery-robotic minimally invasive right upper lobe sleeve lobectomy. Ann Thorac Cardiovasc Surg, 2011, 91(6): 1961-1965.
23.	Pan X, Chen Y, Shi J, et al. Robotic assisted extended sleeve lobectomy after neoadjuvant chemotherapy. Ann Thorac Cardiovasc Surg, 2015, 100(6): e129.
24.	Lin MW, Kuo SW, Yang SM, et al. Robotic-assisted thoracoscopic sleeve lobectomy for locally advanced lung cancer. J Thorac Dis, 2016, 8(7): 1747-1752.
25.	Pan X, Gu C, Wang R, et al. Initial experience of robotic sleeve resection for lung cancer patients. Ann Thorac Cardiovasc Surg, 2016, 102(6): 1892-1897.
26.	Qiu T, Zhao Y, Xuan Y, et al. Robotic-assisted double-sleeve lobectomy. J Thorac Dis, 2017, 9(1): E21.
27.	Nasir BS, Bryant AS, Minnich DJ, et al. Performing robotic lobectomy and segmentectomy: cost, profitability, and outcomes. Ann Thorac Cardiovasc Surg, 2014, 98(1): 208-209.

1. 林皓, 黄佳, 谭强,等. 机器人辅助胸腔镜左肺下叶切除两例. 中华腔镜外科杂志:电子版, 2012, 5(4): 28-31.
2. Melfi FMA, Menconi GF, Mariani AM, et al. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg, 2002, 21(5): 864.
3. 罗清泉, 林皓, 黄佳, 等. 机器人辅助胸腔镜肺叶切除 12 例临床分析. 中国胸心血管外科临床杂志, 2014, 21(1): 25-28.
4. Lacroix V, Nezhad ZM, Kahn D, et al. Pain, quality of life, and clinical outcomes after robotic lobectomy. Thorac Cardiovasc Surg, 2017, 65(5): 344-350.
5. Velez-Cubian FO, Rodriguez KL, Thau MR, et al. Efficacy of lymph node dissection during robotic-assisted lobectomy for non-small cell lung cancer: retrospective review of 159 consecutive cases. Chest, 2014, 145(3):2454-2463.
6. Lee BE, Shapiro M, Rutledge JR, et al. Nodal upstaging in robotic and video assisted thoracic surgery lobectomy for clinical N0 lung cancer. Ann Thorac Surg, 2015, 100(1): 229-234.
7. Park BJ. Robotic lobectomy for non-small cell lung cancer: long-term oncologic results. J Thorac Cardiovasc Surg, 2014, 24(2): 383-389.
8. Park BJ. Robotic lobectomy for non-small cell lung cancer (NSCLC): Multi-center registry study of long-term oncologic results. Ann Cardiothorac Surg, 2012, 1(1): 24.
9. Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stage Ⅰ non-small cell lung cancer: comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265(2):431-437.
10. Agzarian J, Fahim C, Shargall Y, et al. The use of robotic-assisted thoracic surgery for lung resection: A comprehensive systematic review. Semin Thorac Cardiovasc Surg, 2016, 28(1): 182-192.
11. Liang H, Liang W, Zhao L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: a meta-analysis. Ann Surg, 2017 Jun 16. doi: 10.1097/SLA.0000000000002346. [Epub ahead of print].
12. Meyer M, Gharagozloo F, Tempesta B, et al. The learning curve of robotic lobectomy. Int J Med Robot, 2012, 8(4): 448-452.
13. Kent M, Wang T, Whyte R, et al. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg, 2014, 97(1): 242-244.
14. Rajaram R, Mohanty S, Bentrem DJ, et al. Nationwide assessment of robotic lobectomy for non-small cell lung cancer. Ann Thorac Surg, 2017, 103(4): 1092-1100.
15. Nakamura H. Systematic review of published studies on safety and efficacy of thoracoscopic and robot-assisted lobectomy for lung cancer. Ann Thorac Cardiovasc Surg, 2014, 20(2): 93-98.
16. Toker A, Özyurtkan MO, Kaba E, et al. Robotic anatomic lung resections: the initial experience and description of learning in 102 cases. Surg Endosc, 2016, 30(2): 676-683.
17. Montane B, Toosi K, Velez-Cubian FO, et al. Effect of obesity on perioperative outcomes after robotic-assisted pulmonary lobectomy. Surg Innov, 2017, 24(2): 122-132.
18. Echavarria MF, Cheng AM, Velez-Cubian FO, et al. Comparison of pulmonary function tests and perioperative outcomes after robotic-assisted pulmonary lobectomy vs segmentectomy. Am J Surg, 2016, 212(6): 1175-1182.
19. Bao F, Zhang C, Yang Y, et al. Comparison of robotic and video-assisted thoracic surgery for lung cancer: a propensity-matched analysis. J Thorac Dis, 2016, 8(7): 1798-1803.
20. Lazar JF, Spier LN, Hartman AR, et al. Standardizing robotic lobectomy: feasibility and safety in 128 consecutive lobectomies within a single healthcare system. Innovations (Phila), 2017, 12(2): 77-81.
21. Fahim C, Hanna W, Waddell T, et al. Robotic-assisted thoracoscopic surgery for lung resection: the first Canadian series. Can J Surg, 2017, 60(4): 5316.
22. Schmid T, Augustin F, Kainz G, et al. Hybrid video-assisted thoracic surgery-robotic minimally invasive right upper lobe sleeve lobectomy. Ann Thorac Cardiovasc Surg, 2011, 91(6): 1961-1965.
23. Pan X, Chen Y, Shi J, et al. Robotic assisted extended sleeve lobectomy after neoadjuvant chemotherapy. Ann Thorac Cardiovasc Surg, 2015, 100(6): e129.
24. Lin MW, Kuo SW, Yang SM, et al. Robotic-assisted thoracoscopic sleeve lobectomy for locally advanced lung cancer. J Thorac Dis, 2016, 8(7): 1747-1752.
25. Pan X, Gu C, Wang R, et al. Initial experience of robotic sleeve resection for lung cancer patients. Ann Thorac Cardiovasc Surg, 2016, 102(6): 1892-1897.
26. Qiu T, Zhao Y, Xuan Y, et al. Robotic-assisted double-sleeve lobectomy. J Thorac Dis, 2017, 9(1): E21.
27. Nasir BS, Bryant AS, Minnich DJ, et al. Performing robotic lobectomy and segmentectomy: cost, profitability, and outcomes. Ann Thorac Cardiovasc Surg, 2014, 98(1): 208-209.

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Perioperative outcome of robot-assisted pulmonary lobectomy in treating 333 patients with pathological stage Ⅰ non-small cell lung cancer: A single center report

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