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Zirafa et al. Mini-invasive Surg 2020;4:13 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2019.35

Review Open Access

Nodal upstaging robotic lobectomy for non-small
cell lung cancer

Carmelina Cristina Zirafa , Gaetano Romano , Agnese Nesti , Federico Davini , Franca Melfi 1
1
1
2
1
1 Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa
56124, Italy.
2 Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, Pathology and Critical Care, University Hospital of
Pisa, Pisa 56124, Italy.
Correspondence to: Carmelina Cristina Zirafa, Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center
of Surgery, University Hospital of Pisa, Via Paradisa 2, Pisa 56124, Italy. E-mail: c.zirafa@gmail.com

How to cite this article: Zirafa CC, Romano G, Nesti A, Davini F, Melfi F. Nodal upstaging robotic lobectomy for non-small cell
lung cancer. Mini-invasive Surg 2020;4:13. http://dx.doi.org/10.20517/2574-1225.2019.35
Received: 11 Sep 2019 First Decision: 30 Oct 2019 Revised: 8 Jan 2020 Accepted: 7 Feb 2020 Published: 6 Mar 2020

Science Editor: Valérie Lacroix Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Abstract

Nodal upstaging takes place when unsuspected lymph node metastases are detected by pathological evaluation,
after surgical treatment for non-small cell lung cancer. In early stages non-small cell lung cancer, nodal upstaging
amounts to 4.8%-24.6%, depending on several factors, such as accuracy of preoperative staging, localisation and
size of tumour and number of lymph nodes removed. Nodal upstaging is considered a surrogate of the completeness
of thoracic oncologic surgery; for this reason, various studies focus on the evaluation of its rate in the different
surgical approaches used to treat lung cancer. In this analysis, a high percentage of upstaging is observed in robotic
surgery, having similar values to open surgery results, usually considered the gold standard in terms of oncologic
radicality. In fact, thanks to its features, robotic surgery allows carrying out a thorough lymphadenectomy in the
most comfortable manner, ensuring an excellent vision and manoeuvrability of the instruments even in the most
remote areas of the thorax. According to these results, robotic surgery constitutes a safe and radical surgical option,
showing encouraging results on the efficacy of lymphadenectomy and, consequently, on its the long-term outcomes.

Keywords: Nodal upstaging, robotic surgery, lung cancer, non-small cell lung cancer, radicality, oncologic outcomes

INTRODUCTION
Nodal upstaging means presence of unsuspected pathologic metastasis in hilar or mediastinal lymph nodes

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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