Langston, Kyle M, PA-C

Misselbeck, Tim S, MD

Perry, Mark E, MD

Reis, Victor S, MD

Szwerc, Michael F, MD

Talsania, Alec

Werner, Alexander

English

Misselbeck, Timothy S

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of SurgeryRobotic Sublobar Resection for the SurgicalManagement of Isolated Pulmonary NodulesVictor S. Reis MDLehigh Valley Health Network, Victor.Reis@lvhn.orgKyle M. Langston PA-CLehigh Valley Health Network, Kyle_M.Langston@lvhn.orgAlec TalsaniaLehigh Valley Health Network, Alec.Talsania@lvhn.orgAlexander WernerSt. Joseph UniversityMichael F. Szwerc MDLehigh Valley Health Network, Michael_F.Szwerc@lvhn.orgSee next page for additional authorsFollow this and additional works at: http://scholarlyworks.lvhn.org/surgeryPart of the Other Medical Specialties Commons, and the Surgery CommonsThis Presentation is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works byan authorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtReis, V.S., Langston, K.M., Talsania, A., Werner, A., Szwerc, M.F., Misselbeck, T.S., & Perry, M. (2015, May 22). Robotic SublobarResection for the Surgical Management of Isolated Pulmonary Nodules. Presentation presented at Schaeffer Research Day, Lehigh ValleyHealth Network, Allentown, PA.AuthorsVictor S. Reis MD, Kyle M. Langston PA-C, Alec Talsania, Alexander Werner, Michael F. Szwerc MD, Tim S.Misselbeck MD, and Mark E. Perry MDThis presentation is available at LVHN Scholarly Works: http://scholarlyworks.lvhn.org/surgery/709© 2015 Lehigh Valley Health Network Robotic Sublobar Resection for the Surgical Management of Isolated Pulmonary Nodules  Victor S. Reis MD, Kyle M. Langston PA-C, Alec Talsania, Alex Werner, Michael F. Szwerc MD, Timothy S. Misselbeck MD, Mark E. Perry MD  Lehigh Valley Hospital; Allentown, PA Disclosures ▪ None Background Lung Cancer – 2015 United States Estimates  ▪ 221,200 cases (115,610 Male and 105,590 Female) ▪ More deaths than next four most common cancers combined • 158,040 deaths total • 86,380 Male  • 71,660 Female ▪ 13% of all cancer diagnoses ▪ From 2007 to 2011 lung cancer incidence rates decreased by 3.0% per year in men and 2.2% in women ▪ Overall Survival Rates  • One year: 44%  • Five Year: 17% ▪ Early stage Lung cancer (Stage I and II): • Percentage of total diagnoses:  14% • Percentage of five-year survival: 54%  ▪ Source: Cancer Facts & Figures 2015 Background ▪ The surgical management of benign and malignant lung lesions is an evolving field ▪ Techniques for anatomic pulmonary resection: • Rib-Sparing Thoracotomy (Current standard of care) • Video-Assisted Thoracoscopic Surgery • Robotic-Assisted Lung Resection Background ▪ Video Assisted Thoracoscopic Surgery (VATS) paralleled laparoscopy offering a minimally invasive alternative to thoracotomy • Similar mortality rates and long term survival rates with: – Less morbidity – Less postoperative pain – Faster return to work compared to thoracotomy • Limitations of VATS – Lack of depth perception – Rigid instruments – High learning curve  Background ▪ Robotic surgery may offer a minimally invasive technique that is safe, efficacious and easier to learn than VATS • Less post-operative pain • Shorter hospital length of stay  • Better early post-operative quality of life scores ▪ This study assesses the efficacy and perioperative outcomes of robotic-assisted pulmonary sublobar resection. Methods ▪ Retrospective chart review at LVHN from October 2011 to June 2014 ▪ All anatomic lung resections evaluated • Excluded – Open or VATS cases – Lobectomies, sleeve lobectomies, pneumonectomies, wedge resections ▪ 626 lung resections performed • 186 robotic pulmonary resections performed • 36 robotic segmentectomies ▪ Perioperative outcomes evaluated: • Length of stay  30-Day Mortality • Operating room time Conversion rate   • Estimated blood loss Hospital based complications • Number of lymph nodes Tumor size  • Surgical margins  Recurrence ▪ Robotic segmentectomies that required conversions were excluded from further analysis.  Methods ▪ All cases were performed by a single surgeon using the Da Vinci Robotic Surgical platform Results Mean Range Age 65.4 41 – 83 BMI 27.9 17.9 – 42.3 Operative time 121 min 49 – 315 min Estimated blood loss 51.9 mL 20 – 150 mL Tumor size 1.57 cm 0.7 – 3 cm Lymph Node Stations 3.32 0 – 7 Lymph Nodes 4.85 0 – 10 Results Outcome Number Percentage Positive margins 0 0% Recurrence 1 2.94% Readmission rate 4 11.76% 30-day mortality 0 0% Conversion Rate* 2 5.56% Median length of stay 2 days Range 1-17 *Excluded from overall complication rates Results Hospital-based Complication Number Percentage Air leak (>5 days) 4 11.76% Pleural effusion 2 5.88% Recurrent pneumothorax 1 2.94% Atrial fibrillation 1 2.94% Acute kidney injury 1 2.94% Acute blood loss anemia 1 2.94% Discharged with chest tube 7 20.59% Discussion ▪ Approximately 20-30% of anatomic lung resections are performed using VATS •Technical difficulty of VATS may be barrier to minimally invasive chest surgery Discussion ▪ Increased identification of solitary pulmonary nodules ▪ Controversy regarding sublobar resection of early stage NSCLC • Adequate lymph node sampling • Preserves lung volume and function • Controversy: equivalent oncologic outcomes as a traditional lobectomy Discussion ▪ Potential Benefits of Robotic Surgery • High definition 3-D camera • Wristed instruments with 7 degrees of freedom • Dampening of tremor • Ability to control camera and up to 3 instruments simultaneously • Shorter learning curve compared to VATS Conclusions ▪ This study demonstrates the feasibility, safety, and efficacy of robotic-assisted pulmonary sublobar resection for the treatment of isolated lung tumors.    ▪ Further areas of research should focus on comparisons to VATS procedures, cost-benefit analysis and oncologic efficacy. • Longer follow-up period is needed to assess long term oncologic efficacy • Cost analysis should be performed to evaluate if the higher price of the robotic systems outweigh the possibly decreased OR time and hospital stay. References ▪ Pardolesi, A. MD, Park, B. MD, Petrella, F. MD, Borri, A. MD, Gasparri, R. MD & Veronesi, G. MD.  Robotic anatomic segmentectomy of the lung: Technical aspects and initial results.  Ann Thoracic Surgery. 2012; 94:929-34.   ▪ Paoletti, L. MD, Pastis, N.J. MD, Denlinger, C.E. MD, & Silvestri, G.A. MD. A decade of advances in treatment of early-stage lung cancer. Clin Chest Med. 2011; 32:827-38 ▪ Yang, C.J. MD, & D’Amico, T.A. MD. Thorascopic segmentectomy for lung cancer. Ann Thoracic Surgery. 2012; 94:668-81 ▪ Leshnower, B.G. MD, Miller, D.L. MD, Fernandez, F.G. MD, Pickens, A. MD, &Force, S.D. MD. Video-assisted thoracoscopic surgery segmentectomy: A safe and effective procedure. Ann Thoracic Surgery. 2010; 89:1571-6.  ▪ Schuchert, M.J. MD, Abbas, G. MD, Awais, O. MD, Pennathur, A. MD, Nason, K.S. MD, MPH, Wilson, D.O. MD, Siegfried, J.M. PhD, Luketich, J.D. MD, & Landreneau, R.J. MD. Anatomic segmentectomy for the solitary pulmonary nodule and early-stage lung cancer. Ann Thoracic Surgery. 2012; 93:1780-7. ▪ Atkins, B.Z. MD, Harpole, D.H. Jr, MD, Mangum, J.H. BSN, Toloza, E.M. MD, PhD, D’Amico, T.A. MD, & Burfeind, W.R. Jr, MD. Pulmonary segmentectomy by thoracotomy or thoracoscopy: Reduced hospital length of stay with a minimally-invasice approach. Ann Thoracic Surgery 2007; 84:1107-13. ▪ Witte, B., Wolf, M., Hillebrand, H. & Huertgen, M. Complete video-assisted thorascoscopic surgery anatomic segmentectomy for clinical stage I lung carcinoma- technique and feasibility. Interactive CarbioVascular and Thoracic Surgery. 2011; 13:148-52. ▪ Schuchert, M.J. MD, Pettiford, B.L. MD, Pennathur, A. MD, Abbas, G. MD, Awais, O. DO, Close, J. MA, Kilic, A. BS, Jack, R., Landreneau, J.R., Landreneaua,J.P., Wilson, D.O. MD, Luketich, J.D. MD, & Landreneau, R.J. MD. Anatomic segmentectomy for stage I non-small-cell lung cancer: Comparison of video-assisted thoracic surgery versus open approach. The Journal of Thoracic and Cardiovascular Surgery. 2009; 138:1318-25. ▪ Gossot D, Zaimi R, Fournel L, Grigoriou M, Brian E, & Neveu C. Totally thoracoscopic pulomonary anatomic segmentectomies: technical considerations. J Thorac Dis 2013;5(S3):S200-S206.  ▪  Gossot D, Ramos R, Brian E, Christine R, Girrard P, & Strauss C. A totally thoracoscopic approach for pulomary anatomic segmentectomies. Interactive CardioVascular and Thoracic Surgery. 2011; 12:529-33. ▪ Traibi A, Grigoroiu M, Boulitrop C, Urena A, Masuet-Aumatell C, Brian E, Stern J, Zaimi R, & Gossot D.  Predictive factors for complications of anatomical pulomonary segmentectomies. Interactive CardioVascular and Thoracic Surgery. 2013; 17:838-44.  ▪ Fortes, D. L. MD, Tomaszek, S.C. MD, & Wigle, D.A. MD, PhD. Early experience with robotic-assisted lung resection. International Society for Minimally Invasive Cardiothoracic Surgery. 2011; 6:237-42. ▪ Pardolesi, A. MD & Veronesi, G. MD. 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Robotic Sublobar Resection for the Surgical Management of Isolated Pulmonary Nodules

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1714&context=surgery

Robotic Sublobar Resection for the Surgical Management of Isolated Pulmonary Nodules

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