The association of robotic lobectomy volume and nodal upstaging in non-small cell lung cancer


Robotic lung resection for lung cancer has gained popularity over the last 10 years. As with many surgical techniques, there are improvements in outcomes associated with increased operative volume. We sought to investigate lymph-node harvest and upstaging rates for robotic lobectomies performed at hospitals with varying robotic experience. The National Cancer Data Base was queried for patients with early stage non-small cell lung cancer who received lobectomy between 2010 and 2015. Hospitals were stratified into volume categories based on the number of robotic resections performed, as a proxy for robotic experience: low at  ≤ 12, low–middle 13–26, middle–high 27–52, and high volume at greater than or equal to 53. Lymph-node counts and nodal upstaging were compared among these volume categories. 8360 robotic lobectomies were performed. Mean lymph-node counts were for low, low–middle, middle–high, and high-volume robotic lobectomies were 9.8, 11.4, 12.9, and 12.6, respectively (P  < 0.001), while nodal-upstaging rates were 10.3%, 10.2%, 12.8%, and 13.4%, respectively (P < 0.001). Compared to low-volume hospitals, on multivariable analysis, high-volume robotic centers had increased nodal harvest (P < 0.001) and nodal-upstaging rates (P < 0.001). Robotic lobectomies performed at high-volume hospitals have greater lymph-node harvest and upstaging than low-volume hospitals.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Rajaram R, Mohanty S, Bentrem DJ et al (2017) Nationwide assessment of robotic lobectomy for non-small cell lung cancer. Ann Thorac Surg 103:1092–1100

    Article  Google Scholar 

  2. 2.

    Sarkaria IS (2016) Deconstructing robotic lobectomy. J Thorac Cardiovasc Surg 152:998

    Article  Google Scholar 

  3. 3.

    Louie BE, Wilson JL, Kim S et al (2016) Comparison of video-assisted thoracoscopic surgery and robotic approaches for clinical stage i and stage ii non-small cell lung cancer using the society of thoracic surgeons database. Ann Thorac Surg 102:917–924

    Article  Google Scholar 

  4. 4.

    Oh DS, Reddy RM, Gorrepati ML et al (2017) Robotic-assisted, video-assisted thoracoscopic and open lobectomy: propensity-matched analysis of recent premier data. Ann Thorac Surg 104:1733–1740

    Article  Google Scholar 

  5. 5.

    Yang CF, Sun Z, Speicher PJ et al (2016) Use and outcomes of minimally invasive lobectomy for stage i non-small cell lung cancer in the national cancer data base. Ann Thorac Surg 101:1037–1042

    Article  Google Scholar 

  6. 6.

    Yang HX, Woo KM, Sima CS et al (2017) Long-term survival based on the surgical approach to lobectomy for clinical stage I non-small cell lung cancer: comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg 265:431–437

    Article  Google Scholar 

  7. 7.

    Keller DS, Hashemi L, Lu M et al (2013) Short-term outcomes for robotic colorectal surgery by provider volume. J Am Coll Surg 217:1063–1069

    Article  Google Scholar 

  8. 8.

    Yu HY, Hevelone ND, Lipsitz SR et al (2012) Hospital volume, utilization, costs and outcomes of robot-assisted laparoscopic radical prostatectomy. J Urol 187:1632–1637

    Article  Google Scholar 

  9. 9.

    Unger CA, Lachiewicz MP, Ridgeway B (2016) Risk factors for robotic gynecologic procedures requiring conversion to other surgical procedures. Int J Gynaecol Obstet 135:299–303

    Article  Google Scholar 

  10. 10.

    Reddy RM, Gorrepati ML, Oh DS et al (2018) Robotic-assisted versus thoracoscopic lobectomy outcomes from high-volume thoracic surgeons. Ann Thorac Surg 106:902–908

    Article  Google Scholar 

  11. 11.

    Tchouta LN, Park HS, Boffa DJ et al (2017) Hospital volume and outcomes of robot-assisted lobectomies. Chest 151:329–339

    Article  Google Scholar 

  12. 12.

    Fernandez FG, Kozower BD, Crabtree TD et al (2015) Utility of mediastinoscopy in clinical stage I lung cancers at risk for occult mediastinal nodal metastases. J Thorac Cardiovasc Surg 149:35–41

    Article  Google Scholar 

  13. 13.

    Medbery RL, Gillespie TW, Liu Y et al (2016) Nodal upstaging is more common with thoracotomy than with vats during lobectomy for early-stage lung cancer: an analysis from the national cancer data base. J Thorac Oncol 11:222–233

    Article  Google Scholar 

  14. 14.

    Boffa DJ, Kosinski AS, Paul S et al (2012) Lymph node evaluation by open or video-assisted approaches in 11,500 anatomic lung cancer resections. Ann Thorac Surg 94:347–353. (Discussion 353)

    Article  Google Scholar 

  15. 15.

    Douillard JY, Rosell R, De Lena M et al (2006) Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer [Adjuvant Navelbine International Trialist Association (ANITA)]: a randomised controlled trial. Lancet Oncol 7:719–727

    CAS  Article  Google Scholar 

  16. 16.

    Novello B, Renner A, Maurer G et al (2018) Development of the youth emotion picture set. Perception 47:1029–1042

    Article  Google Scholar 

  17. 17.

    Wilson JL, Louie BE, Cerfolio RJ et al (2014) The prevalence of nodal upstaging during robotic lung resection in early stage non-small cell lung cancer. Ann Thorac Surg 97:1901–1906. (Discussion 1906–1907)

    Article  Google Scholar 

  18. 18.

    Bilimoria KY, Stewart AK, Winchester DP et al (2008) The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol 15:683–690

    Article  Google Scholar 

  19. 19.

    Zirafa C, Aprile V, Ricciardi S et al (2019) Nodal upstaging evaluation in NSCLC patients treated by robotic lobectomy. Surg Endosc 33:153–158

    Article  Google Scholar 

  20. 20.

    Darling GE, Allen MS, Decker PA et al (2011) Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg 141:662–670

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Olugbenga T. Okusanya.

Ethics declarations

Conflict of interest

Author ISS has a consultative relationship with Intuitive and CMR robotics. Authors Olugbenga T Okusanya MD, Waseem Lutfi BS, Nicholas Baker MD, Rajeev Dhupar MD, Neil A Christie MD, Ryan M Levy MD, Deirdre Martinez-Meehan MPH, Nalyn Siripong PhD, and James D Luketich MD declare that they have no relevant funding or potential conflicts of interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Okusanya, O.T., Lutfi, W., Baker, N. et al. The association of robotic lobectomy volume and nodal upstaging in non-small cell lung cancer. J Robotic Surg 14, 709–715 (2020).

Download citation


  • Robotic surgery
  • Lobectomy
  • Non-small cell lung cancer
  • Lymph-node harvest
  • Upstaging