Author of

• 20165

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  P1.16 - Surgery (ID 702)

  • Event: WCLC 2017
  • Type: Poster Session with Presenters Present
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)

  • 22805

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    P1.16-003 - Learning Curve for Adoption of Robotic Lobectomy for Early Stage Non-Small Cell Lung Cancer by a Thoracic Surgeon Experienced in Open Lobectomy (ID 7935)

    09:30 - 16:00  |  Presenting Author(s): Shea Gallagher
    • Abstract

    Background:
    Optimal minimally invasive approach in treatment of non-small cell lung cancer (NSCLC) is controversial. Our goals were: 1.To profile the learning curve of adoption of robotic lobectomy by an experienced open thoracic surgeon, novice with VATS-lobectomy techniques; 2. To compare the clinical outcomes of robotic lobectomy vs. historical open lobectomy by the same surgeon (AA).
    
    Method:
    We conducted a retrospective review of 157 consecutive patients undergoing lobectomy for clinical stage I and II NSCLC by one surgeon, previously novice in performing minimally invasive lobectomy, at a single facility between 2007 and 2014. Robotic platform was adopted in 2011. 57 patients underwent open thoracotomy (OT), 40 prior to 2011, and 100 patients underwent robotic lobectomy.
    
    Result:
    The preoperative characteristics and risk profile of the two groups were similar. Aside from longer operative time (a bimodal learning curve), the robotic group (including 13% of patients with open conversion) had significantly lower intraoperative blood loss and overall morbidity rate, significantly shorter chest tube duration and length of stay, and a statistical trend toward lower 90 day mortality and 30 day readmission rate (Table 1). Median number of lymph node stations dissected and percentage of pathologic nodal upstaging were equivalent between robotic and OT groups (5 vs. 4; 17% vs. 14%, respectively). The conversion rate for the latter half of the robotic group was significantly lower (6% vs. 20%, p<0.05). Figure 1
    
    
    
    Conclusion:
    Adoption of robotic platform for lobectomy for NSCLC is safe and feasible without significant preceding VATS experience. In our hands, the learning curve entails approximately 50 robotic lobectomies after which the operative times and conversion rates significantly diminish. In comparison to open thoracotomy, robotics, even during the learning phase, result in a significant reduction in perioperative morbidity and permit equivalent nodal sampling in performing lobectomy for clinical stage I and II patients.