Liverpool Heart and Chest Hospital

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Presentation transcript:

Liverpool Heart and Chest Hospital GIRFT Recommendation – Stage 1 Lung Cancer patients should receive VATS or robotic lobectomy as treatment of choice Steven Woolley, Liverpool Heart and Chest Hospital

Recommendation

Brief (very) summary of evidence for VATS and robotic lobectomy What does the GIRFT report say? What do we do at LHCH? Potential difficulties Discussion

VATS lobectomy – Benefits?

VATS lobectomy – Benefits? VATS approach associated with : significantly lower overall complication rate (p=0.018) significantly shorter chest tube duration (p=0.025) significantly shorter overall length of stay (p=0.016) significantly better survival (p=0.003)

VATS lobectomy – Benefits?

VATS lobectomy – Benefits?

VATS for elderly patients?

VATS and pulmonary function

VATS and pulmonary function

VATS and quality of life

VATS and chemo tolerance?

VATS and immune response?

VATS and cost?

Robotic approach associated with : Decreased length of stay vs open Equivalent to VATS More nodes taken

Summary Overall VATS surgery appears at least equivalent to if not superior to thoracotomy for lung resection Similar reports of robotic surgery, though questions about costs Patients often want minimally invasive surgery

GIRFT Report

VATS lobectomy

VATS lobectomy

VATS lobectomy

At LHCH We do around 500 lobectomies a year 3 VATS surgeons, 2 open Now 4 VATs surgeons(3 robotic), 2 open

Post-Operative Outcomes Robotic lobectomy – 3 days Post-Operative Outcomes No change in LN status higher in VATS group: why? Greater tumour down-staging in open group - due to over-estimate of tumour size pre-operatively and therefore decision to do open surgery as thought to be too big to be removed by VATS?

At LHCH All patients are offered minimally invasive surgery This does mean swapping cases and takes some effort Changes how you discuss things with patients Can create imbalances in work

Difficulties with recommendation Enough capacity for VATS/RATS Surgeons/theatre time Costs involved in theatres Organisational issues if swapping patients Local issues

Thank you