title: Nodal Upstaging in Robotic and Video Assisted Thoracic Surgery Lobectomy for Clinical N0 Lung Cancer.
abstract: BACKGROUND
  Recent multiinstitutional published data have demonstrated increased pathologic nodal upstaging by robotic lobectomy compared with historical video-assisted thoracic surgery (VATS) lobectomy data. To eliminate potential variability from multiple surgical techniques, we compared the rate of nodal upstaging at a single institution where robotic and VATS lobectomy are both performed.
  
  
  METHODS
  We retrospectively reviewed clinically node-negative patients with lung cancer undergoing VATS or robotic lobectomy. Clinical data were recorded in concordance with The Society of Thoracic Surgeons database elements. The rates of pathologic nodal upstaging as well as disease-free and overall survival were calculated.
  
  
  RESULTS
  A total of 211 patients underwent anatomic lobectomy by VATS (n = 158) or robotics (n = 53) from 2009 to 2014. The two groups were statistically similar in their clinical stage, tumor size, location, and histologic evaluation. Within the VATS group, 24 patients experienced nodal upstaging (15.2%), with 13 patients having pN1 disease, and 11 patients having pN2 disease. The robotics group contained 7 patients (13.2%) with nodal upstaging, with 5 patients exhibiting pN1 disease and 2 patients with pN2 disease. When VATS and robotics were compared, there was no significant difference in pathologic upstaging (p = 0.72), 2-year overall survival (88% vs 95%, respectively; p = 0.40), or 2-year disease-free survival (83% vs 93%, respectively; p = 0.48).
  
  
  CONCLUSIONS
  In this comparison of robotic and VATS lobectomy for clinically node-negative lung cancer that was managed with consistent surgical technique and pathologic evaluation, the rate of nodal upstaging achieved by robotics appears similar to VATS. In addition, there were no appreciable differences in disease-free or overall survival.
authors.affiliation: The Daniel and Gloria Blumenthal Cancer Center, Paramus, New Jersey; Division of Thoracic Surgery, Department of Surgery, The Valley Hospital/Valley Health System, Ridgewood, New Jersey. Electronic address: leebe@valleyhealth.com.
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Lee
authors.affiliation: The Daniel and Gloria Blumenthal Cancer Center, Paramus, New Jersey; Division of Thoracic Surgery, Department of Surgery, The Valley Hospital/Valley Health System, Ridgewood, New Jersey.
authors.forename: Mark
authors.initials: M
authors.lastname: Shapiro
authors.affiliation: The Daniel and Gloria Blumenthal Cancer Center, Paramus, New Jersey.
authors.forename: John R
authors.initials: JR
authors.lastname: Rutledge
authors.affiliation: The Daniel and Gloria Blumenthal Cancer Center, Paramus, New Jersey; Division of Thoracic Surgery, Department of Surgery, The Valley Hospital/Valley Health System, Ridgewood, New Jersey.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Korst
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D020775:Thoracic Surgery, Video-Assisted