Robotic hilum-mediastinal lymph nodes dissection for operable non-small cell lung cancer (NSCLC) patients: state of art

Abstract

In the last few years, minimally invasive thoracic surgical techniques were strongly improved enough to become part of daily lung cancer surgical treatment. Although the minimally invasive lobectomy techniques were well-established, controversial still remain about the lymphadenectomy. The first studies about the video-assisted thoracoscopic surgery (VATS) reported better perioperative outcomes compared to thoracotomy but the long-term efficacy is uncertain. The robotic approach represents a technological evolution of VATS procedure that leads to some technical advantages derived from the wide angle of maneuverability of the instruments, which is even superior to that of the human hand. Overall survival after surgery for pN0 non-small cell lung cancer is associated with a higher numbers of lymph nodes resected. This achieves a more accurate staging and a quick starting of the postoperative treatments if needed. Previous studies reported that there are differences in terms of lymphadenectomy with VATS compared to thoracotomy. The thoracoscopic approach showed a lower rate of nodal upstaging. In this review we analyzed the principal technical aspects of the mediastinal lymph nodes dissection and we reported the principal studies that are conducted about the postoperative nodal upstaging following the minimally invasive lung cancer surgery. The results showed that the robotic approach allows to achieve a more accurate lymphadenectomy compared to VATS with a higher number of nodal upstaging. The consequence of this would be that the postoperative oncological treatment can be set faster and more accurately.