Thoracic: Lung Cancer
Outcomes of major complications after robotic anatomic pulmonary resection

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Abstract

Background

There is a paucity of robust clinical data on major postoperative complications following robotic-assisted resection for primary lung cancer. This study assessed the incidence and outcomes of patients who experienced major complications after robotic anatomic pulmonary resection.

Methods

This was a multicenter, retrospective review of patients who underwent robotic anatomic pulmonary resection between 2002 and 2018. Major complications were defined as grade III or higher complications according to the Clavien–Dindo classification. Statistical analysis was performed based on patient-, surgeon-, and treatment-related factors.

Results

During the study period, 1264 patients underwent robotic anatomic pulmonary resections, and 64 major complications occurred in 54 patients (4.3%). Univariate analysis identified male sex, forced expiratory volume in 1 second, diffusion capacity of the lung for carbon monoxide, neoadjuvant therapy, and extent of resection as associated with increased likelihood of a major postoperative complication. Patient age, performance status, body mass index, reoperation status, and surgeon experience did not have a significant impact on major complications. Patients who experienced at least 1 major complication were at higher risk for an intensive care unit stay of >24 hours (17.0% vs 1.4%; P < .001) and prolonged hospitalization (8.5 days vs 4 days; P < .001). Patients who experienced a major postoperative complication had a 14.8% risk of postoperative death.

Conclusions

In this series, the major complication rate during the postoperative period was 4.3%. A number of identified patient- and treatment-related factors were associated with an increased risk of major complications. Major complications had a significant impact on mortality and duration of stay.

Key Words

robotic
anatomic pulmonary resection
major complications

Abbreviations and Acronyms

ARDS
acute respiratory distress syndrome
BMI
body mass index
DLCO
diffusion capacity for carbon monoxide
ECOG
Eastern Cooperative Oncology Group
FEV1
forced expiratory volume in 1 second
ICU
intensive care unit
IQR
interquartile range
NSCLC
non–small cell lung cancer
PET
positron emission tomography
RAL
robotic-assisted lung resection
STS GTSD
Society of Thoracic Surgeons General Thoracic Surgery Database
VATS
video-assisted thoracoscopic surgery

Cited by (0)

This work was funded, in part, by the National Institutes of Health/National Cancer Institute Cancer Support Grant P30 CA008748

Read at the 99th Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, May 4-7, 2019.