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S.C. Grant
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MINI 19 - Surgical Topics in Localized NSCLC (ID 138)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:D. Jablons, B. Stiles
- Coordinates: 9/08/2015, 16:45 - 18:15, 605+607
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MINI19.13 - Nodal Staging via Robotic-Assisted Thoracic Surgery for Clinical Stage I Non-Small Cell Lung Cancer (ID 1018)
17:55 - 18:00 | Author(s): S.C. Grant
- Abstract
- Presentation
Background:
One measure of the quality of thoracic surgery for non-small cell lung cancer (NSCLC) is the adequacy of nodal evaluation; the rate of pathological nodal upstaging can introduce bias in patient selection for surgical therapy. Robotic-assisted thoracic surgery (RATS) offers the ability to sample nodal stations not easily assessed with conventional open surgical methods. We sought to determine the rate of nodal upstaging as a function of the frequency of various lymph node stations sampled in clinical stage I NSCLC patients undergoing RATS.
Methods:
We retrospectively reviewed the charts of patients with right-sided clinical stage I NSCLC who underwent robotic-assisted pulmonary resection with mediastinal lymph node dissection at our institution from 2013 to 2015. CT or PET scan was used to determine clinical stage. The DiPasquale Quality Index (DQI) defines a complete lymph node dissection (LND) as sampling LN 4R, 7, and 9 for right-sided tumors. Our institutional policy for the initial two years of our RATS program was to limit such to right-sided tumors.
Results:
Robotic anatomic lung resection was performed in 70 patients with right-sided clinical stage I NSCLC. The majority were of the upper lobe (41; 58.6%). The most frequent lymph node stations sampled robotically were LN 4R, 7, 9, 10, and 11 (60.6%, 90.1%, 66.2%, 49.3%, and 64.8%, respectively). According to the DQI, 31 (44.3%) tumors underwent complete LND. Pathologic nodal upstaging occurred in 5 patients (7.1% [pN1 4, 5.7%; pN2 1, 1.4%]). Hilar (pN1) upstaging occurred in 2.8%, 0%, and 20.0%, respectively, for cT1a, cT1b, and cT2a tumors. Comparatively, historic hilar upstage rates of video-assisted thoracoscopic surgery (VATS) versus thoracotomy versus recent robotic data for cT1a, cT1b, and cT2a were 5.2%, 7.1%, and 5.7%, versus 7.4%, 8.8%, and 11.5%, versus 3.5%, 8.6%, and 10.8%, respectively. The 1-year overall survival was 97% and the disease-free survival was 98% at 1 year.
Conclusion:
When patients are appropriately selected and proper lymph node sampling is performed, the rate of upstaging with RATS is comparable to VATS and lower than thoracotomy. The rate of hilar upstaging with robotic resection, however, increases with increasing clinical T stage and appears superior to both VATS and thoracotomy for cT2a tumors. This also has implications for patients who may be considered for therapies like stereotactic radiation therapy. Larger studies comparing matched open, VATS, and robotic approaches are necessary to quantify long term survival and local failure rates.
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P2.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 210)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.02-023 - Robotic Thoracic Surgery for Elderly Patients with Non-Small Cell Lung Cancer (ID 1741)
09:30 - 09:30 | Author(s): S.C. Grant
- Abstract
Background:
The evidence supporting robotic pulmonary resection for the management of early stage NSCLC continues to grow. Limited data exist describing the results of elderly patients undergoing these procedures. We compared the outcomes of patients >70 years old versus patients <70 years old undergoing robotic-assisted thoracic surgery.
Methods:
We retrospectively reviewed the medical records of patients treated with robotic-assisted pulmonary resection with lymph node dissection for NSCLC at our institution from March 2013 to the present. Clinical, pathologic, and treatment-related factors were analyzed with regard to perioperative complication rates, hospitalization duration, and clinical outcomes in patients ≥70 versus <70 years old. Categorical and continuous data were compared between age groups using the Chi-square and t-test, respectively. Survival data were described using the Kaplan-Meier method and compared between age groups using the log-rank test.
Results:
This analysis included 101 consecutively treated patients, 40 of whom were over the age of 70 at diagnosis. The cohort was predominantly female (64%), clinical stage I (80%), with an ECOG performance status of 0-1 (97%). Lobectomy (92.5%), wedge resection (13%) and bilobectomy (3%) were performed involving the upper (48.5%), middle (16.8%) and lower (47.5%) lobes. The majority (80%) were right sided due to institutional policies. Open conversion was required in only 3 (3%) patients. The above data did not differ significantly between the two age cohorts. The median chest tube duration (4 days) and length of stay (5 days) were equal in both groups. The median length of epidural anesthesia was 3 days in patients <70 and 2 days in the patients ≥70 years of age. The most common complications for younger vs. older patients included persistent air leak (18% v. 12.5%), atrial fibrillation (8.2% v. 17.5%), urinary retention (3.3% v. 12.5%), and pneumonia (3.3% v. 10%); none of these differences reached statistical significance. Major perioperative complications included one non-fatal myocardial infarction and 2 inpatient deaths secondary to septic shock (one in each age group). The 1-month readmission rate was 4.9% vs. 2.5% for patients younger vs. older than 70 years (p=0.54). The 1-year overall survival was 90% and 89% for younger and older patients, respectively (p=0.35).
Conclusion:
Robotic-assisted thoracic surgery is an appropriate surgical approach for patients older than 70 years of age with early stage NSCLC. Although some complication rates were increased in older patients, these differences did not reach statistical significance and do not appear to be related to the particular surgical procedure performed. Elderly patients with good performance status tolerate minimally-invasive robotic pulmonary resection extremely well and should be considered candidates for this surgical procedure when clinically appropriate.
