Photo Credit: Mohammed Haneefa Nizamudeen

Robotic-assisted thoracic surgery for lung cancer showed a short learning curve and strong outcomes, with 5-year survival rates comparable to open surgery.

Robotic-assisted thoracic surgery (RATS) was associated with an acceptable learning curve and solid oncological outcomes in the first 1,000 patients who underwent lobectomy and systematic lymphadenectomy using RATS, according to a single-center retrospective study published in Lung Cancer.

“In our experience, by classifying the surgical procedure in 5 different time points, we showed how over time, and even over the 100th procedure, the surgeon’s experience continuously improved, but it was after the 12th case performed on average that we identified the first important difference among the analyzed parameters,” wrote corresponding author Monica Casiraghi, MD, and colleagues. “However, we have to underline that such a short learning curve is related to the fact that we are a national high-volume referral center, which allows trainees to perform at least 1 or 2 cases per week.”

The study described 16 years of experience with RATS at the European Institute of Oncology. In addition to the learning curve, researchers evaluated outcomes for 1000 consecutive patients with primary lung cancer who underwent RATS. Among them, 997 underwent lobectomy, and three patients underwent bilobectomy.

Overall, the conversation rate to open surgery was 3.7%, mainly due to technical issues. Just over 21% of patients experienced early, minor postoperative complications, most commonly prolonged air leak and atrial fibrillation. Nearly 3% had early major postoperative complications, which included acute respiratory distress syndrome, pneumonia, and re-thoracotomy. The 30-day operative mortality was 0%; the 90-day operative mortality was 0.1%, according to the study.

The median number of N1 + N2 stations resected was 5, and the median number of N1 + N2 lymph nodes resected was 17.

In 895 patients with non-small cell lung cancer, pathological lymph node upstaging from cN0 to pN1 and pN2 was identified in 17.3%, researchers reported. Over a median 3.9-year follow-up, rates of 5-year overall survival were 89.3% for patients with stage 1 cancer, 74% for patients with stage II cancer, and 61% for patients with stage IIIA cancer. Rates of disease-free survival were 83.6% for patients with stage I cancer, 66.5% for patients with stage II cancer, and 36.4% for patients with stage IIIA cancer.

Researchers described the rates as “excellent,” adding they are “definitely in line with the literature data for open surgery.”