Surgery has remained the cornerstone of lung cancer therapy. Sleeve lobectomy, which is featured by not only the maximal resection of tumors but also the maximal preservation of functional lung parenchyma, has been proved to be a valid therapeutic option for the treatment of some centrally located lung cancer . Evidence points toward equivalent oncologic outcomes with improved survival and quality of life after sleeve resections compared with pneumonectomy. However, the postoperative morbidities and the long-term results after sleeve lobectomy remain controversial, especially in relation to nodal involvement and after induction therapy. With the development of technology, minimally invasive procedures have been performed more and more widely.
ObjectiveTo explore the feasibility of robotic sleeve lobectomy and bronchoplasty and to summarize the experience of quality control and technical process management.MethodsFrom January to December 2018, our hospital completed robotic sleeve lobectomy and bronchoplasty for 5 patients, including the upper right lung lobe in 2 patients, the middle right lung lobe in 1 patient and the lower left lung lobe in 2 patients. There were 3 males and 2 females with an age of 56.6 (39-75) years. The surgical approach was the same as the surgical incision of the robotic lobectomy. During the operation, the lobes were separated, all enlarged mediastinal lymph nodes were cleaned, pulmonary hilum was dissected, pulmonary arteriovenous vessels and bronchi were exposed, and pulmonary vessels were treated. After exposing the main bronchi, the bronchi were cut off at the distal end of the lesion, and the lobes where the lesion was located (including lesions) were excised by sleeve type and the bronchi were continuously sutured with 3-0 Prolene from the back wall for anastomosis. After the anastomosis, no air leakage was found in the expanded lung, and the anastomosis was no longer wrapped.ResultsThe operation time was 147.4 (100-192) min, including bronchial anastomosis time 17.6 (14-25) min. Intraoperative blood loss was 60.0 (20-100) mL, and 20 (9-37) lymph nodes were dissected. Three patients had squamous cell carcinoma, 1 adenocarcinoma, and 1 neuroendocrine tumor. All patients showed negative results in the freezing pathology of bronchial stump during operation. All patients recovered well after surgery, without perioperative complications, and the anastomosis was smooth. Postoperative hospital stay was 10.8 (7-14) days. The patients were followed up for 6 to 12 months without anastomotic stenosis or other complications.ConclusionSince the robot system is a special instrument with 3D vision and 7 degrees of freedom for movable joints, the robotic bronchial suture is more flexible and accurate. The robotic sleeve lobectomy and bronchoplasty are safe and feasible.
ObjectiveThrough the perioperative outcome analysis of da Vinci robot-assisted sleeve lobectomy, to clarify its efficacy and safety.MethodsA retrospective analysis was performed on 10 patients with centrally located lung cancer undergoing robot-assisted sleeve lobectomy from March to December 2019 in our center, including 9 males and 1 female, aged 45-67 (55.0±8.9) years. Preoperative imaging and bronchoscopy showed central non-small cell lung cancer, involving the right upper lung in 3 patients, right lower lung in 2 patients, the left upper lung in 4 patients, and left lower lung in 1 patient. The operation time, Docking time, intraoperative blood loss volume, bronchial anastomosis time, number of dissected lymph nodes, drainage volume and postoperative hospital stay were analyzed.ResultsThe da Vinci robot-assisted bronchial sleeve lobectomy was completed smoothly on 10 patients. The operation time was 135-183 (157.8±14.3) min, Docking time 6-15 (10.0±2.9) min, intraoperative blood loss volume 55-250 (124.5±61.8) mL, bronchial anastomosis time 17-40 (27.7±7.3) min, the number of dissected lymph nodes 16-23 (19.7±2.8), the drainage volume 200-600 (348.0±148.4) mL and postoperative hospital stay 7-11 (8.7±1.6) d. All patients had no bronchopleural fistula, pulmonary infection or atelectasis, and there was no perioperative death. Postoperative pathological findings were all squamous cell carcinoma.ConclusionDa Vinci robot-assisted sleeve lobectomy is safe and effective.
Objective To evaluate the surgical outcomes of neoadjuvant chemoimmunotherapy for sleeve lobectomy. Methods The clinical data of patients diagnosed as non-small-cell-lung-cancer (NSCLC) and evaluated to undergo sleeve lobectomy surgery at TianJin Chest Hospital were retrospectively analyzed. Patients were divided into two groups: a neoadjuvant treatment group and a surgery alone group. The clinical characteristics, perioperative parameters, and postoperative outcomes of two groups were compared. Results Finally 22 patients were collected, including 19 males and 3 females with a median age of 63 years. There were 7 patients in the neoadjuvant treatment group, and 15 patients in the surgery alone group. There was no statistical difference in surgical time, intraoperative bleeding, lymph node dissection, postoperative catheterization time, and postoperative drainage volume between the two groups (P>0.05). In the neoadjuvant treatment group, 1 patient had a second thoracotomy exploration for hemostasis due to bronchial artery bleeding, 2 patients had wound infection, 1 patient had immune-associated pneumonia before surgery, and 1 patient had immune-associated pneumonia before postoperative adjuvant therapy. In the the neoadjuvant treatment group, 1/7 (14.3%) patients had a pathological complete response, and 3/7 (42.9%) patients achieved a major pathological response. Conclusion The surgical difficulty and post-surgical complication rate of sleeve lobectomy with neoadjuvant chemoimmunotherapy are higher than those of surgery alone but also offer appropriate oncological outcomes. Overall, neoadjuvant chemo-immunotherapy sleeve lobectomy can be considered as a treatment option for patients with locally advanced lung cancer.