Effect of Small Body Habitus on Peri-Operative Outcomes after Robotic-Assisted Pulmonary Lobectomy: Retrospective Analysis of 200 Consecutive Patients
Frank O. Velez-Cubian1, Wei Wei Zhang1, Kathryn Rodriguez1, Matthew R. Thau1, Jacques-Pierre Fontaine2, Joseph R. Garrett2, Carla C. Moodie2, Lary A. Robinson2, Eric M. Toloza2, 1University of South Florida College of Medicine, Tampa, FL, 2Moffitt Cancer Center, Tampa, FL
OBJECTIVE: Patients with smaller body surface area (BSA) have smaller pleural spaces, which limit visualization and instrument mobility during video-assisted thoracoscopic (VATS) surgery. We investigated the effects of BSA on outcomes with robotic-assisted VATS lobectomy.
METHODS: We retrospectively analyzed 200 consecutive patients who underwent robotic-assisted lobectomy by one surgeon over 32 months. Patients were separated into Group A (BSA<1.65m2) and Group B (BSA>1.65m2). Operative times, estimated blood loss (EBL), conversion to open lobectomy, perioperative complication rates, chest tube days, hospital length of stays (LOS), and in-hospital mortality were compared between the two groups.
RESULTS: Group A had 39 patients (BSA 1.25m2-1.65m2) and Group B had 161 patients (BSA range 1.66-2.86m2). Both groups had similar prolonged air leak rates (15% vs. 17%; p=1.0), median chest tube duration of 4 days, and median hospital LOS of 5 days. See Table for other outcomes results.
CONCLUSIONS: While patients with BSA<1.65m2 have similar operative times, EBL, overall intraoperative complications, overall postoperative complications (such as atrial fibrillation, prolonged air leaks, and pneumonia), chest tube days, hospital LOS, and in-hospital mortality rates as patients with larger BSA, patients with BSA<1.65m2 have a higher overall conversion rate than, but similar emergent conversion rate as, patients with larger BSA. Thus, our study suggests that robotic-assisted pulmonary lobectomy is feasible and safe in patients with small body habitus, although these patients require better preoperative selection to avoid non-emergent conversion to open lobectomy.
Effect of BSA on Perioperative Outcomes after Robotic-Assisted Pulmonary Lobectomy
|Perioperative Outcome||Group A,
|Median Skin-to-Skin Operative Time (min+SEM)||168 + 16||178 + 7||0.45|
|Median EBL (mL+SEM)||150 + 90||175 + 40||0.60|
|Overall Intra-Operative Complications (n, %)||5 (13%)||12 (7%)||0.33|
|Overall Conversion to Open Lobectomy (n,%)||8 (21%)||13 (8%)||0.04|
|Emergent Conversion to Open Lobectomy (n,%)||2 (5%)||4 (2%)||0.33|
|Atrial Fibrillation (n,%)||2 (5%)||21 (13%)||0.26|
|Mucus Plugs Requiring Intervention (n,%)||1 (3%)||13 (8%)||0.31|
|Pneumonia (n,%)||2 (5%)||21 (13%)||0.26|
|In-Hospital Mortality (n,%)||0 (0%)||5 (3%)||0.58|