Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium.
Eur J Cardiothorac Surg. 2011 Apr;39(4):543-8. doi: 10.1016/j.ejcts.2010.08.009. Epub 2010 Sep 17.
To prospectively evaluate quality of life (QoL) evolution after robotic-assisted thoracoscopic or open anterior mediastinal tumour resection with the European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire-C30 and the lung cancer-specific module, LC-13.
From January 2004 to December 2008, QoL was prospectively recorded in all patients undergoing surgery for mediastinal tumours. A total of 14 patients underwent thoracoscopic resection using the da Vinci robotic system (Intuitive Surgical, Inc., Mountain View, CA, USA), and 22 patients open resection through sternotomy. Questionnaires were administered before surgery and 1, 3, 6 and 12 months, postoperatively, with response rates of 100%, 86.1%, 94.4%; 75.0% and 86.1%, respectively.
Both approaches had comparable preoperative patients' characteristics and QoL subscales. Open resection by sternotomy was characterised by a significant decrease in general functioning 1 month after surgery (physical functioning p=0.001, role functioning p=0.001, and social functioning p=0.044). Patients also complained of increased thoracic pain in the first 3 months after surgery (p=0.017). After a da Vinci robotic resection QoL scores approximated baseline preoperative values 1 month after surgery, with the exception of increase in thoracic and shoulder pain the first 3 months after surgery (p=0.028 and 0.029, respectively).
Numerous techniques have been published with different degrees of invasiveness, generating the existing controversy as to which is the best surgical approach for anterior mediastinal tumours. The high burden of decreased physical functioning reported after sternotomy is not seen after a da Vinci robotic-assisted thoracoscopic resection. The initial experience and postoperative QoL data are excellent and, therefore, the da Vinci robot will stay our future technique of choice for the treatment of resectable mediastinal tumours smaller than 4 cm on imaging techniques.
使用欧洲癌症研究与治疗组织（EORTC）生活质量问卷（QoL）核心问卷 30 项（C30）和肺癌特定模块（LC-13）前瞻性评估机器人辅助胸腔镜或开放性前纵隔肿瘤切除术患者的生活质量（QoL）演变。
2004 年 1 月至 2008 年 12 月，前瞻性记录所有接受纵隔肿瘤手术的患者的 QoL。共 14 例患者采用达芬奇机器人系统（Intuitive Surgical，Inc.，Mountain View，CA，USA）进行胸腔镜切除，22 例患者采用胸骨切开术进行开放性切除。手术前、术后 1、3、6 和 12 个月分别进行问卷调查，患者的应答率分别为 100%、86.1%、94.4%、75.0%和 86.1%。
两种手术方式患者的一般特征和 QoL 亚量表术前比较差异无统计学意义。开放性胸骨切开术患者术后 1 个月一般功能明显下降（躯体功能 p=0.001，角色功能 p=0.001，社会功能 p=0.044）。术后前 3 个月患者还主诉胸部疼痛加重（p=0.017）。达芬奇机器人手术后 QoL 评分在术后 1 个月接近术前基线值，除术后前 3 个月胸部和肩部疼痛增加（p=0.028 和 0.029）外。
已有多种不同程度微创的技术发表，对哪种是治疗前纵隔肿瘤的最佳手术方法存在争议。胸骨切开术后报道的躯体功能下降负担较重的情况，在达芬奇机器人辅助胸腔镜手术后没有出现。达芬奇机器人的初步经验和术后 QoL 数据非常出色，因此，达芬奇机器人将成为我们未来治疗影像学检查小于 4cm 可切除纵隔肿瘤的首选技术。
