THE USE OF DIAGNOSTIC ROBOTIC ASSISTED SEGMENTECTOMY ACCELERATES THE LUNG CANCER PATHWAY

Objectives Robotic assisted thoracoscopic surgery (RATS) facilitates complex pulmonary segmentectomy which offers one-stage diagnostic and therapeutic management of small pulmonary nodules. We aimed to explore the advantages of a faster pathway and preservation of function against the disadvantage of unnecessary morbidity in benign cases. Methods In a prospective observational study all patients with small, central solitary pulmonary nodules deemed suspicious of malignancy by a lung multidisciplinary team were offered RATS segmentectomy without a pre or intra operative biopsy. 41/50 of all patient had pre-operative PET-CT and 38/50 had a two CT scans. As the lesions could not be easily located intraoperatively, a segmental resection margin sufficient only to obtain a R0 resection was obtained using intraoperative fluorescence imaging and near-infrared thoracoscopy. Results Expressed as median (range) Fifty RATS segmentectomies were performed in 50 patients (28:22F) over a 26 month period. A median of 2 (1–4) segments were removed; 32 left (19 upper;13 lower) and 18 right (8 upper;1 middle;10 lower). The diagnostic/therapeutic intervention occurred at 24.5 days (6–69) into the patient pathway after initial consultation. 31/37 malignant and 7/13 benign nodules were PET avid. Conversion to open segmentectomy was required in 5 (10%) cases (2/13 for benign disease) due to adhesions or bleeding. Overall hospital stay was 6 (2–52) days. There was no requirement for postoperative ventilation nor in hospital mortality. Pathological nodule size was 16 (6–57) mm. Malignancy was found in 37 (74%) patients: primary adenocarcinoma in 26 (55%) including 2 Tmi; 4 T1a; 6 T1b;4 T1c;4 T2a. Of 13 benign cases, 5 proceeded to treatment for tuberculosis. Conclusions RATS segmentectomy offers a rapid, safe and effective one-stop therapeutic biopsy in early lung cancer and in some benign cases and should be considered as a modification of the patient pathway. Its effectiveness will be compared to protocols involving preresectional diagnostic biopsy or observation.