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Robotic One Anesthetic Diagnosis and Treatment (ROADAT): A Novel Program for Expedited Lung Cancer Care.
Kevin M. Dickson*1, Benjamin A. Palleiko1, Mark W. Maxfield1, Rahul Sood2, Andrew Fischer3, Karl Uy1, Isabel Emmerick1, Feiran Lou1
1Surgery, UMass Chan, Worcester, MA; 2Interventional Pulmonology, UMass Chan, Worcester, MA; 3Pathology, UMass Chan, Worcester, MA

Introduction: Early diagnosis and treatment of lung cancer improves outcomes. To reduce delay between diagnosis and surgical treatment, we initiated a program for lung nodules that combined robotic navigational bronchoscopy, rapid on-site evaluation (ROSE) cytology, and resection in the same setting.

Methods: The Robotoci One Anesthetic Diagnosis and Treatment (ROADAT) program incluced patients with high-risk clinical stage I and IIa lung nodules identified on CT scans. Subjects underwent robotic navigational bronchoscopy and immediate ROSE. If non-small cell lung cancer (NSCLC) was identified, robotic-assisted anatomic resection was performed durign the same anesthetic event. In cases of negative results, the decision to proceed with anatomic resection was based upon level of clinical suspiscion for cancer.

Results: Between December 2021 and February 2023, 17 patients underwent ROADAT. Pathologic stage ranged from IA1 to IIB. Overall, ROSE and tissue pathology were concordant in 16 cases (94%). In 14 cases, ROSE identified NSCLC. In one case, ROSE showed chronic inflammation, which was confirmed on tissue pathology from wedge resection. In one case, ROSE was completely negative, and procedure was terminated. Another case showed negative ROSE, but clinical suspiscion led to lobectomy and final pathology showed adenocarcinoma. The ROADAT program reduced time from nodule detection (initial concderning CT) to resection, as compared to standard, multi-event diagnosis and treatment approach (76 days vs. 123 days, p = 0.0044).

Conclusion: ROADAT is a safe, effective procedure that combines navigational bronchoscopy, immediate cytologic diagnosis, and surgical resection for lung cancer, while significantly reducing the time from nodule detection to treatment.
A flow diagram that illustrates the specific details of the ROADAT procedure is depicted.

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