{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T02:52:33Z","timestamp":1767495153930,"version":"build-2065373602"},"reference-count":34,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2021,9,26]],"date-time":"2021-09-26T00:00:00Z","timestamp":1632614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Robotic-assisted pulmonary resection has greatly increased over the last few years, yet data on the application of robotic surgery in high-risk patients are still lacking. The objective of this study is to evaluate the perioperative outcomes in ASA III-IV patients who underwent robotic-assisted lung resection for NSCLC. Between January 2010 and December 2017, we retrospectively collected the data of 148 high-risk patients who underwent lung resection for NSCLC via a robotic approach at our institution. For this study, the prediction of operative risk was based on the ASA-PS score, considering patients in ASA III and IV classes as high-risk patients: of the 148 high-risk patients identified, 146 patients were classified as ASA III (44.8%) and two as ASA IV (0.2%). Possible prognostic factors were also analysed. The average hospital stay was 6 days (8\u201330). Post-operative complications were observed in 87 (58.8%) patients. Patients with moderate\/severe COPD developed in 33 (80.5%) cases post-operative complications, while elderly patients in 25 (55%) cases, with a greater incidence of high-grade complications. No difference was observed when comparing the data of obese and non-obese patients. Robotic surgery appears to be associated with satisfying post-operative results in ASA III-IV patients. Both marginal respiratory function and advanced age represent negative prognostic factors. Due to its safety and efficacy, robotic surgery can be considered the treatment of choice in high-risk patients.<\/jats:p>","DOI":"10.3390\/jcm10194408","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T04:55:33Z","timestamp":1632718533000},"page":"4408","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Robotic Surgery for Non-Small Cell Lung Cancer Treatment in High-Risk Patients"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3240-9313","authenticated-orcid":false,"given":"Carmelina Cristina","family":"Zirafa","sequence":"first","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaetano","family":"Romano","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Sicolo","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Cariello","sequence":"additional","affiliation":[{"name":"Cardiothoracic and Vascular Anaesthesia and Intensive Care, Department of Anaesthesia and Critical Care Medicine, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7783-0262","authenticated-orcid":false,"given":"Riccardo","family":"Morganti","sequence":"additional","affiliation":[{"name":"Section of Statistics, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Conoscenti","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa","family":"Hung-Key","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Davini","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franca","family":"Melfi","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,26]]},"reference":[{"key":"ref_1","unstructured":"WHO (2019, October 23). The Global Cancer Observatory, \u201cCancer Today\u201d\u2014International Agency for Research on Cancer. Available online: https:\/\/gco.iarc.fr\/today\/data\/factsheets\/cancers\/15-Lung-fact-sheet.pdf."},{"key":"ref_2","unstructured":"WHO (2019, October 23). The Global Cancer Observatory, Estimated Age-Standardized Incidence and Mortality Rates (World) in 2020. Available online: http:\/\/gco.iarc.fr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/ACO.0000000000000149","article-title":"Preoperative evaluation of the patient with lung cancer being considered for lung resection","volume":"28","author":"Choi","year":"2015","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"222","DOI":"10.21037\/jtd.2018.12.44","article-title":"Refined risk stratification for thoracoscopic lobectomy or segmentectomy","volume":"11","author":"Ruoyu","year":"2019","journal-title":"J. Thorac. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1080\/17476348.2018.1448270","article-title":"Techniques for lung surgery: A review of robotic lobectomy","volume":"12","author":"Chen","year":"2018","journal-title":"Expert Rev. Respir. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1245\/s10434-017-6232-5","article-title":"Video-Assisted Thoracic Surgery for Patients with Advanced Stage Non-small Cell Lung Cancer","volume":"24","author":"Cao","year":"2017","journal-title":"Ann. Surg. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"519","DOI":"10.21037\/tlcr.2020.03.27","article-title":"Minimal invasive surgery in locally advanced N2 non-small cell lung cancer","volume":"10","year":"2021","journal-title":"Transl. Lung Cancer Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1016\/j.athoracsur.2015.11.018","article-title":"Use and Outcomes of Minimally Invasive Lobectomy for Stage I Non-Small Cell Lung Cancer in the National Cancer Data Base","volume":"101","author":"Yang","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.jtcvs.2009.03.030","article-title":"Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer","volume":"138","author":"Flores","year":"2009","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.suronc.2019.02.003","article-title":"Long-Term oncologic results for robotic major lung resection in non-small cell lung cancer (NSCLC) patients","volume":"28","author":"Zirafa","year":"2019","journal-title":"Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.jtcvs.2009.04.026","article-title":"Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy","volume":"138","author":"Villamizar","year":"2009","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1016\/j.athoracsur.2017.06.020","article-title":"Robotic-Assisted, Video-Assisted Thoracoscopic and Open Lobectomy: Propensity-Matched Analysis of Recent Premier Data","volume":"104","author":"Oh","year":"2017","journal-title":"Ann. Thorac. Surg."},{"key":"ref_13","unstructured":"American Society of Anesthesiologists (2019, October 23). ASA Physical Status Classification System. Available online: https:\/\/www.asahq.org\/standards-and-guidelines\/asa-physical-status-classification-system."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.ijsu.2015.04.079","article-title":"ASA class is a reliable independent predictor of medical complications and mortality following surgery","volume":"18","author":"Hackett","year":"2015","journal-title":"Int. J. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s10916-021-01758-z","article-title":"Reliability of the ASA Physical Status Classification System in Predicting Surgical Morbidity: A Retrospective Analysis","volume":"45","author":"Li","year":"2021","journal-title":"J. Med. Syst."},{"key":"ref_16","unstructured":"U.S. Department of Health and Human Services (2017). Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.soc.2016.02.006","article-title":"Robotic Lung Resection for Non-Small Cell Lung Cancer","volume":"25","author":"Wei","year":"2016","journal-title":"Surg. Oncol. Clin. N. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"210","DOI":"10.21037\/acs.2019.03.03","article-title":"The evolution of robotic thoracic surgery","volume":"8","author":"Zirafa","year":"2019","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"597416","DOI":"10.3389\/fsurg.2021.597416","article-title":"Extended Robotic Pulmonary Resections","volume":"8","author":"Scheinerman","year":"2021","journal-title":"Front. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/S1010-7940(97)01150-0","article-title":"Comparison of two preoperative indices to predict perioperative mortality in non-cardiac thoracic surgery","volume":"11","author":"Prause","year":"1997","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_21","unstructured":"LoCicero, J., Feins, R.H., Colson, Y.L., and Rocco, G. (2018). Complications of Thoracic Surgical Procedures. Shields\u2019 General Thoracic Surgery, Lippincott Williams & Wilkins (LWW). [8th ed.]."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1034\/j.1399-3003.2000.15e03.x","article-title":"Exercise capacity and extent of resection as predictors of surgical risk in lung cancer","volume":"15","author":"Brutsche","year":"2000","journal-title":"Eur. Respir. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/S0169-5002(02)00014-4","article-title":"Impact of COPD on pulmonary complications and on long-term survival of patients undergoing surgery for NSCLC","volume":"37","author":"Sekine","year":"2002","journal-title":"Lung Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1479973120925430","DOI":"10.1177\/1479973120925430","article-title":"Lung cancer resection and postoperative outcomes in COPD: A single-center experience","volume":"17","author":"Roy","year":"2020","journal-title":"Chron. Respir. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1016\/S0003-4975(03)00650-7","article-title":"Preoperative risk assessment for marginal patients requiring pulmonary resection","volume":"76","author":"Burke","year":"2003","journal-title":"Ann. Thorac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/S0003-4975(00)01853-1","article-title":"Identification of prognostic factors determining risk groups for lung resection","volume":"70","author":"Bernard","year":"2000","journal-title":"Ann. Thorac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/S1010-7940(01)00886-7","article-title":"Pulmonary lobectomy for lung cancer: A prospective study to compare patients with forced expiratory volume in 1 s more or less than 80% of predicted","volume":"20","author":"Santambrogio","year":"2001","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13019-018-0748-z","article-title":"Robotic lobectomy has the greatest benefit in patients with marginal pulmonary function","volume":"13","author":"Kneuertz","year":"2018","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"5143","DOI":"10.21037\/jtd.2017.10.144","article-title":"The long-term impact of post-operative pulmonary complications after video-assisted thoracic surgery lobectomy for lung cancer","volume":"9","author":"Wang","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1378\/chest.128.1.237","article-title":"Similar long-term survival of elderly patients with non-small cell lung cancer treated with lobectomy or wedge resection within the surveillance, epidemiology, and end results database","volume":"128","author":"Mery","year":"2005","journal-title":"Chest"},{"key":"ref_31","first-page":"1","article-title":"Obesity paradox in patients undergoing lung lobectomy\u2014Myth or reality?","volume":"18","author":"Ostruszka","year":"2018","journal-title":"BMC Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.1016\/j.chest.2020.11.010","article-title":"Sex and Survival After Surgery for Lung Cancer: A Swedish Nationwide Cohort","volume":"159","author":"Sachs","year":"2021","journal-title":"Chest"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1309\/AJCPQF24NYWNMVMG","article-title":"The prognostic impact of sex on surgically resected non-small cell lung cancer depends on clinicopathologic characteristics","volume":"135","author":"Sterlacci","year":"2011","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2466-8-22","article-title":"Predictors of long time survival after lung cancer surgery: A retrospective cohort study","volume":"8","author":"Roth","year":"2008","journal-title":"BMC Pulm. 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