ORIGINAL ARTICLE   

Minerva Surgery 2021 February;76(1):80-9

DOI: 10.23736/S2724-5691.20.08395-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Postoperative outcomes, lymph node dissection and effects on costs among thoracotomy, video-assisted and robotic-assisted lobectomy for clinical stage I non-small cell lung cancer

Roberto GULLO ¹, Carola M. GAGLIARDO ² ✉, Manuela PALAZZOLO ¹, Calogero PORRELLO ¹, Leonardo GULOTTA ³, Felice LO FASO ⁴, Gaspare GULOTTA ⁵

¹ Department of Thoracic Surgery, Paolo Giaccone University Hospital, Palermo, Italy; ² Department of Surgical, Oncological and Stomatological Sciences, Paolo Giaccone University Hospital, Palermo, Italy; ³ Department of General and Oncologic Surgery, Gaetano Martino University Hospital, Messina, Italy; ⁴ Department of Thoracic Surgery, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy; ⁵ Department of General and Emergency Surgery, Paolo Giaccone University Hospital, Palermo, Italy

BACKGROUND: Thoracotomy, video-assisted thoracoscopic surgery (VATS) and robotic assisted thoracoscopic surgery (RATS)-lobectomy are widely accepted procedures for the surgical treatment of clinical (c)stage I non- small cell lung cancer (NSCLC). In the current literature which procedure gives more benefits is still debated. We present a comparison between these three procedures in term of advantages and postoperative outcomes.
METHODS: A multicentric study about 259 lobectomies from 2013 to 2019: 128 patients underwent TL, 96 VATS and 35 RATS. Different variables were retrospectively analyzed among these three cohorts of patients with diagnosis of cStage I NSCLC.
RESULTS: Rate of major complications comparable in VATS, RATS and TL; Advantages for RATS in minor complications (TL 34.4% vs. VATS 18.75% vs. RATS 8.57%. P=0.0015), postoperative days in Intensive Care Unit, days to chest tube removal, length of postoperative hospitalization (P<0.0001) and number of lymph nodes dissected (P=0.0257). Operating times are shorter in VATS than RATS (P<0.05). Pain (NRS Scale) is comparable.
CONCLUSIONS: TL remains the conventional approach for stage II-IIIA(N2) NSCLC. RATS showed great advantages, but its higher operating time and costs, mostly, today don’t justify its adoption as gold standard for the surgical treatment of cStage I NSCLC, instead of VATS.

KEY WORDS: Pneumonectomy; Thoracotomy; Thoracic surgery, video-assisted; Robotic surgical procedures; Lung neoplasms