Is Robotic-Assisted Surgery Associated With Receipt of Guideline-Directed Lymph Node Sampling in Wedge Resection for...

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Wedge resection is equivalent to lobectomy for early-stage non-small cell lung cancer (NSCLC).
• High-quality wedge resection requires adherence to 3+1 lymph node sampling (LNS).

Purpose of the Study:

• To evaluate if robotic-assisted wedge resections increase compliance with 3+1 LNS guidelines.
• To identify factors associated with achieving 3+1 LNS in NSCLC patients.

Main Methods:

• Analysis of the Society of Thoracic Surgeons General Thoracic Database (July 2021 - January 2023).
• Inclusion of patients with clinical T1 N0 M0 NSCLC undergoing wedge resection with LNS.
• Multivariable regression to determine factors associated with 3+1 LNS.

Main Results:

• 4162 patients were analyzed; 43.6% achieved 3+1 LNS.
• Robotic-assisted wedge resection showed the strongest association with 3+1 LNS compliance (OR 2.53, P < .001) compared to VATS.
• Open or VATS approaches were less likely to achieve 3+1 LNS compared to robotic.

Conclusions:

• Less than half of patients undergoing wedge resection for early-stage NSCLC met 3+1 LNS guidelines.
• Robotic-assisted wedge resection is significantly more likely to achieve guideline-concordant LNS.
• The robotic approach is the most influential factor for successful 3+1 LNS.