Robotic Lobectomy Feasible for Older Adults With NSCLC, Analysis Finds

Robotic-assisted lobectomy for early-stage non-small cell lung cancer (NSCLC) is safe and feasible in patients older than 75 years, suggests a single-institution retrospective study published in Frontiers in Oncology. 

“Robotic surgery is demonstrated to improve oncological outcomes, with a complication and conversion rate comparable to video-assisted surgery,” wrote authors from IRCCS Regina Elena National Cancer Institute in Rome, Italy, in the study introduction. “However, the perioperative results of robotic-assisted lobectomy for early-stage lung cancer in patients older than 75 years have not been clearly assessed, and the best treatment strategy for NSCLC affecting the elderly is often omitted from guidelines and clinical trials, leading to management ambiguities.”

To investigate the feasibility and the perioperative outcome of robotic lobectomy in the patient population, researchers analyzed 103 patients older than 75 who underwent the procedure at the cancer institute.

Among the patients, 35 had postoperative complications, according to the study. A comparison of patients with and without postoperative complications identified significantly lower predicted postoperative forced expiratory volumes in the first second (FEV₁) and forced vital capacity in patients with complications.

Additionally, the rate of upstaging and unexpected nodal metastases were higher in patients with postoperative complications, the study found.

“The analysis of the factors that can predict the complication rate in this specific surgical population showed that the predicted postoperative FEV₁ and the preoperative staging have to be carefully evaluated to help reduce postoperative complications,” researchers advised. “In the literature, there are no specific guidelines for the preoperative staging in the elderly population. Our results showed that the nodal disease could have an impact on the postoperative complications regardless of the kind of lymphadenectomy performed.”

Reference:
Gallina FT, Tajè R, Forcella D, et al. Perioperative outcomes of robotic lobectomy for early-stage non-small cell lung cancer in elderly patients. Front Oncol. Published online November 28, 2022. doi:10.3389/fonc.2022.1055418