Abstract
This retrospective study aims to evaluate safety, accuracy and cost-efficiency of robotic thoracoscopic diagnostic wedge and immediate anatomic resection without pre-operative diagnosis of peripheral nodules suspicious of cT1N0 lung cancers.
We queried our robotic thoracic surgery institutional database (1/1/2017 to 12/31/2025) to identify patients with cT1N0 tumors amenable to intra-operative wedge for cancer diagnosis and immediate curative-intent anatomic resection. Data included demographics, pre-operative biopsy, operative details, post-operative outcomes, Mayo cancer score, estimated costs associated with cancer diagnosis and resection.
786 patients were included in this study. 585 patients (including 65 having non-diagnostic pre-operative biopsy) underwent diagnostic wedge resection: 100 (17.1%) benign and 485 (82.9%) malignant diagnosis, 467 had anatomic resections (one-stage diagnosis and therapy, Group 1); 266 patients had pre-operative biopsy with definite cancer diagnosis in 201 (75.8%) and 197 had anatomic resection (two-stage diagnosis then therapy, Group 2) while 65 (24.4%) non-diagnostic biopsies requiring subsequent diagnostic resection. 118 patients had wedge resection only (Group 3). Three groups had similar pre-operative characteristics. Larger tumors, more lobectomy, higher incidence of nodal upstaging and costs were observed in Group 2. Discordance between intra-operative and post-operative pathology was noted in 11 (2.3%) of 485 patients with 9 having history of carcinomas. No complications were reported in 88.6%, 83.7%, and 94.1% of patients in Groups 1 to 3 respectively.
One-stage robotic resection is a safe, accurate and cost-efficient strategy in this patient population. Pre-operative biopsy is useful in patients with prior carcinoma history to minimize diagnostic discordance associated with under/over-treatments.