Editor's note: The 104th Annual Meeting of the American Association for Thoracic Surgery (AATS) will be held April 27-30, 2024 at the Metropolitan Convention Centre in Toronto, Ontario, Canada. AATS is one of the most prestigious thoracic surgery events in the world, and this annual meeting will focus on the core values of excellence, scholarship and innovation, bringing together many internationally renowned surgeons to conduct in-depth discussions on current research hotspots and clinical problems. Please follow in the footsteps of the editor to see what major research there are!
Abstract: 93
Initial experience with single-port robotic thoracoscopic surgery using a single-port robotic surgical system
Background:
This study aims to report the initial experience of single-port robotic thoracoscopic surgery in more than 100 patients using a single-port robotic surgical system in a single center.
Research Methods:
Between November 2020 and June 2023, 117 patients underwent single-port robotic thoracoscopic surgery, and patient characteristics, intraoperative and postoperative outcomes were retrospectively analyzed.
Findings:
The types of surgery included thymectomy, mediastinal lumpectomy, large lung resection, lobectomy, esophagectomy, and enucleation of esophageal submucosal tumors (SMT) in 41, 13, 54, 2, 5, and 2 cases, respectively.
The mean operating time and indwelling time of chest drainage tube were 132.7±68.0 min and 1.2±0.5 days for thymectomy, 93.3±26.5 min and 1.0±0 days for mediastinal lumpectomy, 187.2±55.8 min and 2.5±1.5 days for large lung resection, 71±12 min and 1.0±0 days for lobectomy, and 485±112 min and 12±4.6 for esophagectomy Esophageal SMT enucleation, 170±30 min and 5.5±0.5 d.
No thoracotomy or sternotomy was performed. One patient underwent video-assisted thoracoscopic surgery, and two patients introduced an additional port. In addition, postoperative complications were higher than grade IIIb in 2 patients.
Conclusions of the study
The results suggest that single-port robotic thoracoscopic surgery with a single-port robotic surgical system is feasible and safe. With the continuous advancement and innovation of instruments in robotic systems, more complex thoracic surgeries have been made possible.
Abstract: P104
Exploring the role of surgical resection in stage II small cell lung cancer based on data from the National Cancer Database
Background:
SCLC is a type of lung cancer with a high degree of malignancy, and the treatment effect is poor, and the traditional treatment methods are chemotherapy and radiotherapy. The role of surgical therapy in stage II SCLC is unclear. The investigators sought to determine whether surgery would provide a survival benefit to patients with stage II SCLC.
Research Methods:
Based on data from the National Cancer Database (NCDB) from 2004 to 2020, the clinical characteristics, treatment strategies, and survival outcomes of patients diagnosed with stage II SCLC were evaluated according to the 8th edition of the AJCC staging guidelines. Patients with incomplete data, no treatment, bilateral disease, extensive excision (including chest wall, pericardium, or diaphragm, etc.), or surgery not intended for the treatment of SCLC were excluded. Patients who underwent surgical resection as part of treatment were compared to those who did not undergo surgical resection, predisposediency matching based on clinical stage, primary tumor site, lateral presentation, tumor size, age at diagnosis, sex, ethnicity, and Charlson-Deyo score. The Kaplan-Meier method was then used to compare the overall survival rates of the two groups.
Findings:
The researchers identified 7,069 patients with stage II SCLC. Only 10% (710/7069) of patients underwent surgery: 73% of them underwent lobectomy (519/710), 22% underwent lower lobectomy (157/710) and 5% underwent pneumonectomy (34/710). 90% (6359/7069) received non-surgical treatment, of which 79% (4771/6359) received chemotherapy. In the surgical group, 75% (537/710) of patients received chemotherapy with or without radiotherapy. Overall survival was higher in the surgery group: 1 year, 78.6% vs. 72.2%, 5 years, 32.0% vs. 23.8%, P values less than 0.05.
In the propensity-matched cohort, 325 patients in each group were similar in age, sex, ethnicity, Charlson-Deyo score, T stage, N stage, tumor size, and use of chemotherapy and/or radiotherapy. Propensity-matched patients had higher overall survival rates of 84.5% vs. 70.4% at 1 year and 35.7% vs. 23.9% at 5 years, all with P values less than 0.05.
Abstract:P183
Clinicopathologic and genomic risk factors associated with brain metastases after resection of lung adenocarcinoma
Background:
To determine the clinicopathologic and genomic features associated with brain metastases after complete resection of LUAD and to assess survival after relapse.
Research Methods:
This study performed a retrospective study of patients with stage I-IIIA LUAD who underwent complete resection (2011-2020) and received or did not receive systemic therapy in the perioperative period. Patients with < follow-up of 2 years, mucinous histology, minimally invasive or adenocarcinoma in situ were excluded. Preoperative brain imaging was performed according to NCCN guidelines. Next-generation sequencing (NGS) is performed on the primary tumor in a subset of patients. A grey model of brain metastasis/no brain metastasis mortality competition risk was constructed.
Findings:
A total of 2660 patients underwent primary LUAD resection, of which 1% (26/2660) had a pathologic stage of 0, 74% (1994/2660) had stage I, 12% (331/2660) had stage II, and 12% (309/2660) had stage III. The median follow-up was 60 months, and the cumulative incidence of brain metastases over 10 years was 9.8%.
In patients with brain metastases, the median time from surgery to brain metastases was 21 months (IQR 10-42 months). In 44% (91/207) of patients, the brain was the only site of recurrence, and 75% (156/207) of the brain was the site of the first recurrence. Higher SUVmax, neoadjuvant therapy, lymphatic invasion, and pathologic stage III of primary tumors were associated with the occurrence of brain metastases. Median survival after brain metastases was 18 months (95% CI: 15.6-24 months). Of the patients with brain metastases, 79% (163/207) received topical brain therapy, of which 47% (97/207) received radiotherapy alone, 6% (12/207) received craniotomy alone, and 26% (54/207) received both radiotherapy and craniotomy. NGS was performed on 1085 (41%) primary tumors, of which 77 had recurrence in the brain. Multivariate analysis combining clinicopathological and genomic characteristics showed that lymphatic invasion, pathological stages II and III, and TP53 mutations were associated with the occurrence of brain metastases. Epidermal growth factor receptor (EGFR) mutations are not associated with brain metastases.
Conclusions of the study
The development of brain metastases after LUAD resection usually occurs within two years. Invasive tumor biology marked by high SUVmax, lymphatic invasion, and TP53 mutation are associated with the occurrence of brain metastases.
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