1. 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

2. Recommendation

3. 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

4. VATS lobectomy – Benefits?

5. 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)

6. VATS lobectomy – Benefits?

7. VATS lobectomy – Benefits?

8. VATS for elderly patients?

9. VATS and pulmonary function

10. VATS and pulmonary function

11. VATS and quality of life

12. VATS and chemo tolerance?

13. VATS and immune response?

14. VATS and cost?

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

18. 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

19. GIRFT Report

20. VATS lobectomy

21. VATS lobectomy

22. VATS lobectomy

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

24. 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?

25. 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

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

27. Thank you