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P175. Increased Opioid Consumption and Complication Rates in Robot-Assisted Versus Uniportal Video-Assisted Thoracoscopic Surgery for Non-Small Cell Lung Cancer

Xing Wei Poster Presenter
Sichuan Cancer Hospital & Institute
Chengdu, Sichuan 
China  - Contact Me

I am a dedicated Thoracic Surgeon and Clinical Researcher with a particular focus on lung cancer surgery. My fervent commitment to enhancing patient outcomes and improving their quality of life permeates both my clinical practice and research endeavors.

My research concentrates chiefly on Patient-Reported Outcomes (PROs) in the context of lung cancer surgery. PROs serve as a window into the patients' experience, offering invaluable insights into their symptoms, quality of life, and functional status, straight from the individuals themselves. By incorporating PROs into our surgical outcomes assessment, we can paint a more comprehensive picture of how surgery impacts the lives of patients. My team and I are deeply committed to exploiting the potential of PROs to guide patient care. This includes uncovering factors influencing postoperative recovery and architecting interventions to address specific symptoms or functional limitations.

Beyond PROs, I harbor a strong passion for Shared Decision-Making (SDM) in the realm of lung cancer surgery. SDM is a collaborative effort, wherein patients and healthcare providers join forces to make informed treatment decisions that dovetail with the patient's values and preferences. This approach is not only adopted in my own practice but I also actively advocate for its wider use across the healthcare system, viewing it as a top priority.

Lastly, my academic duties extend to the review of articles and grant applications pertaining to my field of expertise. I deeply believe in the significance of peer review as a mechanism for upholding the quality and rigor of scientific research. My commitment lies in offering constructive criticism, providing insightful feedback that contributes to propelling our understanding of thoracic surgery to new heights.

Sunday, May 4, 2025: 9:00 AM - 4:00 PM
Seattle Convention Center | Summit 
Room: Poster Area, Exhibit Hall 

Description

Objective: To compare intraoperative and postoperative opioid consumption, as well as clinical outcomes, between robot-assisted thoracoscopic surgery (RATS) and uniportal video-assisted thoracoscopic surgery (U-VATS) in patients undergoing pulmonary resection for non-small cell lung cancer (NSCLC). Methods: We conducted a retrospective analysis at a cancer specialty hospital using data extracted from the CN-PRO-Lung3, an ongoing longitudinal prospective cohort study. For our analysis, we included patients from CN-PRO-Lung3 who were enrolled between April 2021 and November 2022 and met our study criteria. The inclusion criteria were: patients who underwent RATS or U-VATS; had postoperative pathology confirming primary lung cancer; and received sublobar resection, lobectomy, or extended resection surgery. The exclusion criteria were: patients who had secondary surgeries; had non-specific resection types; or had received preoperative neoadjuvant therapy. The primary outcome was opioid usage, measured intraoperatively and postoperatively using oral morphine equivalents (OME). Secondary outcomes included various perioperative clinical outcomes. Baseline characteristics and postoperative outcomes were compared between the RATS and U-VATS groups using appropriate statistical tests such as the Mann-Whitney U test, chi-square test, and Fisher's exact test. Results: After identifying 1,737 patients from the cohort, a total of 1,057 patients were included in the analysis. RATS was associated with a higher frequency of lobectomy (57.51% vs. 40.39%, p < 0.001) and systematic lymph node dissection (56.48% vs. 23.84%, p < 0.001). Intraoperatively, RATS patients received a higher total OME (median 94.2 mg vs. 84.9 mg, p = 0.003). Postoperatively, 89.12% of RATS patients received opioids compared to 56.94% of U-VATS patients (p < 0.001), with RATS patients also receiving a higher total OME postoperatively (median 48 mg vs. 42 mg, p < 0.001). Additionally, RATS was associated with higher rates of perioperative complications classified as Clavien-Dindo grade ≥2 (13.47% vs. 4.98%, p < 0.001). Conclusions: RATS is associated with increased intraoperative and postoperative opioid consumption and higher rates of significant perioperative complications compared to U-VATS. These findings suggest that while RATS may offer certain surgical advantages, it may also entail greater analgesic needs and a higher risk of complications.

Authors
Xing Wei (1), Rumei Xiang (2), Wei Dai (1), Ding Yang (3), Hongfan Yu (4), Lin Huang (5), Yangjun Liu (6), Kunpeng Zhang (7), Qiuling Shi (2), Qiang Li (1)
Institutions
(1) Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, (2) School of Public Health, Chongqing Medical University, Chongqing, Chongqing, (3) Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, (4) College of Biomedical Engineering, Chongqing Medical University, Chongqing, Chongqing, (5) Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, (6) Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, (7) Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, Shanghai

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