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Dao Minh Nguyen
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P1.16 - Surgery (ID 702)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.16-022 - Incorporating Robotics to the Surgical Treatment of Thoracic Neoplasms: 5-Year Experience at an Academic Center (ID 10126)
09:30 - 09:30 | Presenting Author(s): Dao Minh Nguyen
- Abstract
Background:
Video-assisted thoracoscopic surgery (VATS) is a well-recognized oncologically sound and safe surgical modality to treat appropriately selected thoracic neoplasms. It is, however, limited by 2D imaging and rigid instrumentations. Such restrictions are addressed by robotic platform offering high-definition 3D optics and angulated instrumentations with multiple degrees of movements. We incorporated this novel technology to our thoracic surgical armamentarium in June 2012 to augment our minimally invasive thoracic surgery (MITS) capability. Between 6/1/2012 and 5/30/2017, we have performed 566 robotic video-assisted thoracic surgical (R-VATS) procedures
Method:
The objective of this retrospective analysis of our prospectively maintained database is to appraise our short-term outcomes and to perform comparative analysis of our data with published results.
Result:
We performed 231 anatomic lung resections (lobectomy/segmentectomy; 98% for lung cancers) and 256 wedge lung resections (196 therapeutic/137 for lung cancers), 60 mediastinal procedures (50% for neoplasm) and 9 esophageal procedures (all benign). Regarding R-VATS anatomic lung resection, there were 8 conversions to open thoracotomy (3.4%); the 30-day morbidity and mortality for the remaining 231 cases are 25% (3% potentially life-threatening) and 0.4% (1/231). The postoperative hospital length of stay (LOS) is 3.46±2.48 (median 3.00) days. 25% patients undergoing R-VATS lobectomy/segmentectomy were ≥75 years old (79.78±3.64 (median 79.00), n=53). Comparing to those ≤75 years old (67.19±10.21 (median 68.00), n=170), older patients had a slight increase in LOS (4.46 ±3.75 (median 3.00) versus 3.15±1.83 (median 3.00), p<0.001) but similar morbidity (34% versus 24%, p=0.16). Our single institution short-term surgical outcomes including LOS, number of intrathoracic lymph node harvested, incidence of nodal upstaging (cN0 to pN1/2), 30-day perioperative mortality and morbidity compare very favorable to data reported by individual academic centers or by databases. The learning curve for robotic anatomic lung resection as judged by the duration of time spent at the console performing the complete procedure is long as it would take about 100 cases to achieve a steady-state average of 150 minutes per case.
Conclusion:
We successfully incorporate this novel technology to our current thoracic surgery practice without adversely affecting surgical outcomes of lung resections for malignancies as exempified by our short-term outcomes of R-VATS anatomic lung resections. Our own results are very comparable to those reported by other single instituitons or better than those reported by large multi-institutional database analysis. Long-term oncologic outcomes and financial impacts of adopting R-VATS are being evaluated.
