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Tesi etd-03172018-121659

Thesis type
Tesi di dottorato di ricerca
The application of robotic technology for major surgery in clinical locally advanced NSCLC: evaluation of operative, post-operative and oncologic outcomes
Settore scientifico disciplinare
Corso di studi
tutor Prof.ssa Melfi, Franca
Parole chiave
  • robotic surgery
  • post-operative outcomes
  • lung cancer
Data inizio appello
Data di rilascio
Riassunto analitico
The aim of this study is to evaluate the safety, the feasibility and the radicality of the use of robotic surgery to perform lobectomy in locally advanced NSCLC. Data of 60 consecutive patients with locally advanced (cIII) NSCLC who underwent robotic lobectomy has been analysed and compared with data of an analogous cohort of patients treated with open surgery, considered the gold standard surgical approach. For this analysis was evaluated operative, post-operative and oncologic results.<br>In robotic group there were 60 patients with median age of 67, 2 years (range 44 – 81), with median operative time of 216 minutes (range 100 – 390) and median postoperative hospital stay of 5,1 days (range 4 – 17). <br>Open group was constituted of 60 patients with median age of 68, 7 years (range 47 – 82), with median operative time of 126 minutes (range 65 – 245), and median postoperative hospital stay of 6,1 days (range 5 – 19)<br>We evaluated quality of life using questionnaire SF-12, obtaining in robotic group after 90 days a Physical Component Summary (PCS) of 47,66 ± 9,56 and a Mental Component Summary (MCS) of 39.89 ± 7.25, in open group PCS was 38.22 ± 7,13 and MCS was 40.09 ± 7.01.<br>Analyzing oncologic data, we observed loco-regional recurrence in 16 patients (26,7%) and distant metastases in 7 patients (11,7%) of robotic group, with a median OS of 65,6 months (SD±19,9). In open group were detected loco-regional recurrence in 18 patients (30%) and in 8 patients (13.3%) distant metastases, with a median OS of 61,5 months (SD±18,7). <br>Our experience confirms that the robotic technique is safe and feasible with a low rate of postoperative mortality and a low incidence of complications. Evaluating post-operative quality of life of patients, we observed a statistically significant difference between the robotic and the thoracotomic groups about Physical Health Score (PCS), suggesting an advantage of minimally invasive surgery with regard to physical recovery after surgery. <br>Our long term oncologic data is in agreement with the most consistent open surgery results, confirming that robotic approach assurances a good oncologic radicality.<br>In this study we have examined surgical results in locally advanced NSCLC patients, proving that robotic system, used by skilled surgeon, allows to perform also complex surgical procedures, with high safety level and excellent operative and post-operative results.<br>