Robotic Assisted Thoracic Surgery For The Treatment Of Locally Advanced NSCLC

ObjectiveRobot-assisted thoracic surgery(RATS)has many advantages over traditional Videoassisted thoracoscopic surgery(VATS).In the past,RATS were mostly used for the treatment of early stage lung cancer.With the rapid development of surgical technics,more and more locally advanced non-small cell lung cancer(NSCLC)patients are being treated by minimally invasive surgery.This study intends to retrospectively analyze the clinical results of 1000 consecutive cases of robotic lung surgery in our center,and compare them with VATS and thoracotomy in the treatment of locally advanced NSCLC.MethodsThe clinical data of 1000 patients who underwent robotic lung resection in the Shanghai Lung Tumor Clinical Medical Center of Shanghai Chest Hospital were collected and summarize surgical experience.The surgical results of stage c IIB-IIIA NSCLC were compared with those treated by VATS of the same period,and base on which we conducted a prospective randomized clinical trial to compare RATS and thoracotomy for the treatment of cN2 NSCLC.ResultsA total of 121 patients with stage IIB-IIIA NSCLC were enrolled,including 36 RATS and 85 VATS.The postoperative morbidity was similar between the two groups(13.9%for RATS vs.15.3% for VATS;P=0.84).The postoperative morbidity was similar between the two groups(13.9% for RATS vs.15.3% for VATS;P=0.84).Robotic lobectomy was associated with a shorter length of postoperative hospital stay(4d vs.5d,P﹤0.01)and more counts of lymph nodes harvested(13 vs.10,P﹤0.01).The median disease-free survival(DFS)for the RATS and VATS groups were 31.1 months and 33.8months,respectively.The corresponding 3-year DFS was 40.3% in the RATS group and47.6% in the VATS group(P=0.74).The 3-year OS was 75.7% in RATS and 77.0% in the VATS group(P=0.75).58 patients in the RATS group and 55 patients in the thoracotomy group were enrolled in the RCT.Compared with thoracotomy,RATS was associated with less intraoperative blood loss and shorter chest duration and less pain for the treatment of cN2 NSCLC.ConclusionsRobotic-assisted lung resection is safe and effective.In the treatment of locally advanced NSCLC,the robotic approach resulted in shorter postoperative length of stay,greater lymph node assessment and similar long-term outcome compared with VATS.