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M. Thein



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    P3.07 - Poster Session 3 - Surgery (ID 193)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P3.07-015 - Robotic-Assisted Pulmonary Resection for Non-Small Cell Lung Cancer in High Risk Veteran Population: A Single Institution Experience (ID 1488)

      09:30 - 09:30  |  Author(s): M. Thein

      • Abstract

      Background
      The value of robotics in surgical treatment of lung cancer is not well-defined. Our goal was to examine the surgical results of robotic-assisted pulmonary resections in a high risk profile veteran population. .

      Methods
      A retrospective analysis of a single VA facility’s robotic thoracic surgical experience from January 2011 to May 2013 was performed. A total of 70 consecutive patients had undergone robotic pulmonary resections, by a single surgeon, for treatment of non-small cell lung cancer (NSCLC). All preoperative, intra- and postoperative data including length of stay (LOS) and readmission rates were collected.

      Results
      60 lobar and 10 sublobar (wedge) pulmonary resections plus mediastinal/hilar lymph node staging had been performed. Mean number of lymph node stations sampled were 3.5 (range 2-7). Mean age was 68 (40-86). 33 (47%) patients were active smokers. 42 (60%) patients had hypertension, 34 (48%) had COPD, 15 (21%) had BMI >30, 14 (20%) had DM, 13 (19%) had documented coronary artery disease, 11 (16%) had history of alcohol abuse, 7 (11%) had renal insufficiency defined as creatinine > 1.3, and 3 (4%) had received induction therapy. Average preoperative FEV1 and DLCO were 76% and 68% of predicted, respectively. Stage distribution is shown in Table 1. Intra- and postoperative data are summarized in Table 2. Thirty day mortality was 1.4% (1). 20 patients sustained at least one complication (28.5% morbidity). Mean LOS for the entire cohort was 7 days; mean LOS for those 57 patients having undergone completely robotic resection was 6 days. Prolonged air leak was the most prevalent reason for an extended LOS. Table 1: Clinical and pathologic stage distribution.

      Total N=70 Clinical Stage : N(%) Pathologic Stage: N(%)
      Ia 49 (70%) 34 (48.6%)
      Ib 6 (8.6%) 16 (22.9%)
      IIa 8 (11.4%) 6 (8.6%)
      IIb 3 (4.3%) 4 (5.7%)
      IIIa 3 (4.3%) 9 (12.8%)
      IIIb 0 0
      IVa 0 0
      IVb 1 (1.4%) 1 (1.4%)
      Table 2: Intraoperative and postoperative outcomes
      N %
      Intraoperative data
      OR extubation 66 94
      Conversion to open 13 18
      Blood transfusion 1 1.4
      Death 0 0
      Average EBL 83
      Postoperative data
      Atrial fibrillation 10 14
      Bronchoscopy 9 12.8
      Prolonged air leak (>7days) 8 11.4
      Blood transfusion 7 10
      Pneumonia 5 7.1
      Respiratory failure (reintubation) 2 2.8
      Reoperation within 30 days 2 2.8
      Readmission within 30 days 2 2.8
      Pulmonary embolism 1 1.4
      DVT 1 1.4
      Average Chest Tube Days 4.1
      EBL: estimated blood loss; DVT: deep vein thrombosis

      Conclusion
      This is the first report on feasibility and outcome of robotic thoracic surgery in a high risk veteran population. Our data suggest that robotic-assisted pulmonary resection for NSCLC can be performed with acceptable morbidity and mortality in this cohort.