Upstaging and survival after robotic-assisted thoracoscopic lobectomy for non-small cell lung cancer.
Mediastinal involvement in resected non-small-cell lung cancer mandates adjuvant therapy and affects survival. This study investigated lymph node dissection efficacy, lymph node metastasis detection, and survival after robotic-assisted lobectomy for non-small-cell lung cancer.



We retrospectively analyzed patients who underwent robotic-assisted lobectomy for non-small-cell lung cancer. Survival was assessed through chart reviews, Social Security Death Registry, and national obituary searches. Kaplan-Meier survival curves by clinical and pathologic stage were compared by log-rank and Cox regression analysis.



In 249 patients (mean age, 67.8 ± 0.6 years), mean individual mediastinal lymph nodes retrieved was 7.7 ± 0.3 lymph nodes, with mean of 13.9 ± 0.4 N1+ mediastinal lymph nodes. There were 159 (63.9%) clinical stage I versus 134 (53.8%) pathologic stage I patients, with 67 (26.9%) patients upstaged (20 cN0 to pN1; 17 cN0 to pN2; 4 cN1 to pN2) and 37 (14.9%) downstaged. One-year and 3-year survival rates, respectively, changed between clinical stage I (clinical stage I, 91% and 70%; clinical stage II, 80% and 64%; clinical stage III, 78% and 57%; clinical stage IV, 71% and 45%) and pathologic stage (pathologic stage I, 92% and 75%; clinical stage II, 83% and 73%; pathologic stage III, 75% and 44%; and pathologic stage IV, 67% and 0%).



Mediastinal lymph node dissection during robotic-assisted lobectomy adequately assesses lymph node stations and detects occult lymph node metastasis. Stage-specific survival is affected by upstaging.
Morsani College of Medicine, Tampa, FL.
Kavian
K
Toosi
Department of Surgery, University of South Florida, Tampa, FL.
Frank O
FO
Velez-Cubian
Morsani College of Medicine, Tampa, FL.
Jessica
J
Glover
Morsani College of Medicine, Tampa, FL.
Emily P
EP
Ng
Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL.
Carla C
CC
Moodie
Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL.
Joseph R
JR
Garrett
Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL; Department of Surgery, University of South Florida, Tampa, FL; Department of Oncologic Sciences, University of South Florida, Tampa, FL.
Jacques P
JP
Fontaine
Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL; Department of Surgery, University of South Florida, Tampa, FL; Department of Oncologic Sciences, University of South Florida, Tampa, FL. Electronic address: eric.toloza@moffitt.org.
Eric M
EM
Toloza
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D065287:Robotic Surgical Procedures / Q000379:methods* / Q000401:mortality; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome