Leveraging Technology To Help The Patient: Combined Robotic Bronchoscopic Biopsy With Surgical Resection During The Same Anesthetic Event

P0179 

Abstract Submission 

Lucas Weiser (1), Woosik Yu (2), Claire Perez (3), Kellie Knabe (3), Sevannah Soukiasian (4), Charles Fuller (3), Raffaele Rocco (1), Andrew Brownlee (5), Harmik Soukiasian (3)

(1) Cedars Sinai Medical Center, Los Angeles, CA, (2) Ajou University Hospital, Los Angeles, CA, (3) Cedars-Sinai Medical Center, Los Angeles, CA, (4) Cedars Sinai Medical Center, Encino, CA, (5) Cedars-Sinai Medical Center, Studio City, CA

Lucas Weiser    -  Contact Me
Cedars Sinai Medical Center

Woosik Yu    -  Contact Me
Ajou University Hospital

Claire Perez    -  Contact Me
Cedars-Sinai Medical Center

Kellie Knabe    -  Contact Me
Cedars-Sinai Medical Center

Sevannah Soukiasian    -  Contact Me
Cedars Sinai Medical Center

Charles Fuller    -  Contact Me
Cedars-Sinai Medical Center

Raffaele Rocco    -  Contact Me
Cedars Sinai Medical Center

Andrew Brownlee    -  Contact Me
Cedars-Sinai Medical Center

*Harmik Soukiasian    -  Contact Me
Cedars-Sinai Medical Center

Lucas Weiser    -  Contact Me
Cedars Sinai Medical Center

Objective:
Delay from diagnosis to treatment of early-stage lung cancer negatively affects survival. Due to variable wait times for different biopsy modalities, diagnostic wedge resection is often required at the time of planned oncologic resection. With a benign resection rate of 20-25% these operations can be viewed as potentially unnecessary surgeries. We compared two approaches for diagnosis and treatment for patients with a high pretest probability of resectable malignancy to demonstrate methods to mitigate delays to treatment

Methods:
Patients from 2021 to 2024 with a lung nodule who did not have a prior attempt at diagnosis and had a Mayo Clinic solitary pulmonary nodule malignancy risk score ≥ 90% were offered a Single Anesthetic robotic bronchoscopy with Biopsy, followed by anatomic Resection, if indicated (SABR). The control group included contemporaneous patients undergoing traditional surgical wedge resection (WR) for diagnosis, followed by anatomic resection if indicated. All patients with benign diagnoses that did not undergo surgery were followed until their nodule decreased in size or resolved.

Results:
A total of 138 patients were identified (65 SABR, 73 WR). There were no differences in clinical characteristics or nodule location between the two groups. The mean time from clinic to definitive treatment was 30 ± 21 days in the SABR group and 32 ± 23 days in the diagnostic surgery group (p=0.545). Mean nodule size was larger (2.0 ± 0.9 vs 1.7 ± 0.7, p=0.006) and mean OR time was longer (218 ± 76 minutes vs 113 ± 43 minutes, p<0.001) in the SABR group. There were no differences in post-operative complications or 90-day readmission between groups. Eleven SABRs were stopped at biopsy alone due to a diagnosis precluding surgical resection (Figure 1). Benign resection rate of 7.6% in the SABR group was significantly lower than the rate of 21.9% in the diagnostic surgery group (p = 0.037). All SABRs that were stopped at biopsy with a benign diagnosis had a decrease in nodule size or repeat benign biopsy within 6 months of their bronchoscopy.

Conclusion:
Combined robotic bronchoscopy with biopsy and anatomic lung resection under a single period of anesthesia significantly reduces the rate of benign and unnecessary surgery, as well as mitigates delay from diagnosis to surgery.

Lung Cancer