Fast Track Pathway for Lung Cancer: The Integration of ION Robotic-Assisted Bronchoscopy With Robotic Thoracic Surgical Resection

Background: Delays between diagnosis and definitive treatment in early-stage lung cancer can lead to disease progression and patient anxiety. Recent advances in robotic-assisted bronchoscopy and surgery provide opportunities to streamline care and reduce treatment timelines.To evaluate the feasibility, safety, and diagnostic performance of an integrated Fast Track protocol combining ION robotic-assisted bronchoscopy with radioactive marker placement and subsequent robotic surgical resection in patients with small or indeterminate pulmonary nodules. Methods: A retrospective cohort study was conducted on consecutive patients undergoing ION-guided bronchoscopy with technetium-99m-labeled marker placement, followed by robotic resection, from December 1, 2024, to March 31, 2025. The protocol included preoperative imaging (Day 1), bronchoscopy with biopsy and marker placement (Day 2), and robotic surgery (Day 3). Primary outcomes included diagnostic yield and need for preliminary wedge resection; secondary outcomes assessed localization accuracy, perioperative results, and procedural complications. Results: Ten patients were included, with a median age of 59 years and a median nodule diameter of 14.0 mm. Diagnostic yield from bronchoscopy was 90%, and localization success was 100%. Robotic resection (lobectomy in 9 cases, segmentectomy in 1) was performed the day after bronchoscopy. No procedural complications occurred, and the median hospital stay was six days. Conclusions: This integrated Fast Track pathway is feasible, safe, and effective in expediting diagnosis and treatment for early-stage lung cancer. However, the small sample size of this initial series (n = 10) limits the generalizability of these findings, which should be interpreted in the context of our institutional case selection, favoring nodules accessible by the ION system and patients with good performance status. The protocol enhances clinical efficiency by consolidating diagnostic and therapeutic steps while maintaining high diagnostic accuracy. Broader validation is warranted in larger multicenter studies.