title: The prevalence of nodal upstaging during robotic lung resection in early stage non-small cell lung cancer.
abstract: BACKGROUND
  Pathologic nodal upstaging can be considered a surrogate for completeness of nodal evaluation and quality of surgery. We sought to determine the rate of nodal upstaging and disease-free and overall survival with a robotic approach in clinical stage I NSCLC.
  
  
  METHODS
  We retrospectively reviewed patients with clinical stage I NSCLC after robotic lobectomy or segmentectomy at three centers from 2009 to 2012. Data were collected primarily based on Society of Thoracic Surgeons database elements.
  
  
  RESULTS
  Robotic anatomic lung resection was performed in 302 patients. The majority were right sided (192; 63.6%) and of the upper lobe (192; 63.6%). Most were clinical stage IA (237; 78.5%). Pathologic nodal upstaging occurred in 33 patients (10.9% [pN1 20, 6.6%; pN2 13, 4.3%]). Hilar (pN1) upstaging occurred in 3.5%, 8.6%, and 10.8%, respectively, for cT1a, cT1b, and cT2a tumors. Comparatively, historic hilar upstage rates of video-assisted thoracoscopic surgery (VATS) versus thoracotomy for cT1a, cT1b, and cT2a were 5.2%, 7.1%, and 5.7%, versus 7.4%, 8.8%, and 11.5%, respectively. Median follow-up was 12.3 months (range, 0 to 49). Forty patients (13.2%) had disease recurrence (local 11, 3.6%; regional 7, 2.3%; distant 22, 7.3%). The 2-year overall survival was 87.6%, and the disease-free survival was 70.2%.
  
  
  CONCLUSIONS
  The rate of nodal upstaging for robotic resection appears to be superior to VATS and similar to thoracotomy data when analyzed by clinical T stage. Both disease-free and overall survival were comparable to recent VATS and thoracotomy data. A larger series of matched open, VATS and robotic approaches is necessary.
authors.affiliation: Division of Thoracic Surgery, Swedish Cancer Institute and Medical Center, Seattle, Washington.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wilson
authors.affiliation: Division of Thoracic Surgery, Swedish Cancer Institute and Medical Center, Seattle, Washington. Electronic address: brian.louie@swedish.org.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Louie
authors.affiliation: Division of Thoracic Surgery, University of Alabama Birmingham, Birmingham, Alabama.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Cerfolio
authors.affiliation: Division of Thoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Park
authors.affiliation: Division of Thoracic Surgery, Swedish Cancer Institute and Medical Center, Seattle, Washington.
authors.forename: Eric
authors.initials: E
authors.lastname: Vallières
authors.affiliation: Division of Thoracic Surgery, Swedish Cancer Institute and Medical Center, Seattle, Washington.
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Aye
authors.affiliation: Division of Thoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdel-Razek
authors.affiliation: Division of Thoracic Surgery, University of Alabama Birmingham, Birmingham, Alabama.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Bryant
authors.affiliation: Division of Thoracic Surgery, Swedish Cancer Institute and Medical Center, Seattle, Washington.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Farivar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D015995:Prevalence; D012189:Retrospective Studies; D012371:Robotics