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Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery

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Neoadjuvant Therapy in Robotic Lung Surgery: Elevating Surgical Complexity Without Compromising Outcomes.

Inés Serratosa¹, Carlos Déniz^1,2, Camilo Moreno¹

¹Department of Thoracic Surgery, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.

|December 17, 2024

Summary

Neoadjuvant therapy for non-small cell lung cancer (NSCLC) before robotic surgery increases operative time and prolonged air leaks but is feasible. Robotic-assisted thoracic surgery (RATS) can be safely integrated for selected patients.

Keywords:

lung cancer neoadjuvant therapy robotic assisted thoracic surgery

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Area of Science:

Thoracic Surgery
Surgical Oncology
Pulmonology

Background:

Neoadjuvant therapy, including chemotherapy and immunotherapy, is standard for locally advanced non-small cell lung cancer (NSCLC).
Its impact on postoperative outcomes after robotic-assisted thoracic surgery (RATS) requires further characterization.
Understanding these outcomes is crucial for optimizing treatment pathways.

Purpose of the Study:

To evaluate the effect of neoadjuvant therapy on postoperative outcomes in patients undergoing RATS for NSCLC.
Key outcomes assessed include operative time, conversion rates, and complications.
This study aims to inform clinical practice regarding neoadjuvant therapy and RATS.

Main Methods:

Retrospective cohort analysis of 253 NSCLC patients undergoing RATS (February 2019 - August 2024).
Propensity score matching was used to balance patient characteristics between groups.
Comparison of operative time, conversion rates, and postoperative complications.

Main Results:

The neoadjuvant therapy group experienced longer operative times (250 min vs. 221 min, p=0.001).
No significant difference in conversion rates to open surgery was observed (8.7% vs. 3.9%, p=0.5).
A higher incidence of prolonged air leaks (>5 days) was noted in the neoadjuvant group (39.13% vs. 35.21%, p<0.001).

Conclusions:

Robotic-assisted thoracic surgery is feasible following neoadjuvant therapy in NSCLC patients.
This approach can be safely integrated into clinical practice for carefully selected individuals.
Further research is needed to refine patient selection and postoperative management strategies.