Leveraging technology to help the patient: Combined robotic bronchoscopic biopsy with surgical resection during the same anesthetic event

Abstract

Objective

Delays from diagnosis to treatment of early-stage lung cancer affect survival, with variable biopsy wait times often requiring diagnostic wedge resection at planned oncologic resection, resulting in a 20% to 25% benign resection rate. We compared 2 approaches to reduce treatment delays in patients with high pretest probability of resectable malignancy.

Methods

Patients from 2021 to 2024 with a lung nodule who did not have a previous attempt at diagnosis and had a Mayo Clinic solitary pulmonary nodule malignancy risk score ≥90% were offered a Single Anesthetic robotic bronchoscopy with Biopsy, followed by anatomic Resection, if indicated (SABRR). The control group included contemporaneous patients undergoing traditional surgical wedge resection (WR) for diagnosis, followed by anatomic resection if indicated. All patients with benign diagnoses that did not undergo surgery were followed until their nodule decreased in size or resolved.

Results

A total of 138 patients were identified (65 SABRR, 73 WR). There were no differences in clinical characteristics or nodule location between the 2 groups. The mean time from clinic to definitive treatment was 30 ± 21 days in the SABRR group and 32 ± 23 days in the WR group (P = .545). Mean nodule size was larger (2.0 ± 0.9 vs 1.7 ± 0.7, P = .006) and mean operating room time was longer (218 ± 76 minutes vs 113 ± 43 minutes, P < .001) in the SABRR group. There were no differences in postoperative complications or 90-day readmission between groups. Eleven SABRRs were stopped at biopsy alone because of a diagnosis precluding surgical resection. Benign resection rate of 7.6% in the SABRR group was significantly lower than the rate of 21.9% in the WR group (P = .037). All SABRRs that were stopped at biopsy with a benign diagnosis had a decrease in nodule size or repeat benign biopsy within 6 months of their bronchoscopy.

Conclusions

Combined robotic bronchoscopy with biopsy and anatomic lung resection under a single period of anesthesia significantly reduces the rate of benign and unnecessary surgery, as well as mitigates delay from diagnosis to surgery.