Division of Thoracic Surgery, Hackensack University Medical Center, Hackensack, NJ 07601, USA.
J Thorac Cardiovasc Surg. 2012 Feb;143(2):383-9. doi: 10.1016/j.jtcvs.2011.10.055. Epub 2011 Nov 20.
OBJECTIVE(S): We evaluated a large series of patients undergoing robotic lobectomy for the treatment of early-stage non-small cell lung cancer (NSCLC) to assess long-term oncologic efficacy.
A multi-institutional retrospective review of patients undergoing robotic lobectomy for NSCLC was performed. Robotic lobectomy was performed in a manner consistent with the Cancer and Leukemia Group B (CALGB) consensus video-assisted thoracic surgery (VATS) lobectomy technique using a robotic surgical system. Perioperative outcomes and long-term follow-up were recorded prospectively, and survival was calculated from the date of surgery to last follow-up.
From November 2002 through May 2010, a total of 325 consecutive patients underwent robotic lobectomy for early-stage NSCLC at 3 institutions. The median age of patients was 66 years (range, 30-87 years), and 37% (120) were female. The majority were in clinical stage I (IA, 247; IB, 63). Conversion rate to thoracotomy was 8% (27/325). Overall morbidity rate was 25.2% (82/325), and major complication rate was 3.7% (12/325). There was 1 in-hospital death (0.3%), and the median length of stay was 5 days (range, 2-28 days). Pathologic stage distribution was 54% (176) IA, 22% (72) IB, 13% (41) IIA, 5% (15) IIB, and 6% (21) IIIA. With a median follow-up of 27 months, overall 5-year survival was 80% (95% confidence intervals [CI] = 73-88), and by pathologic stage, 91% (CI = 83-99) for stage IA, 88% (CI = 77-98) for stage IB, and 49% (CI = 24-74) for all patients with stage II disease. Overall 3-year survival for patients with stage IIIA disease was 43% (CI = 16-69).
Robotic lobectomy for early-stage NSCLC can be performed with low morbidity and mortality. Long-term stage-specific survival is acceptable and consistent with prior results for VATS and thoracotomy.
我们评估了一组接受机器人肺叶切除术治疗早期非小细胞肺癌（NSCLC）的患者，以评估长期肿瘤学疗效。
对 3 家机构接受机器人肺叶切除术治疗 NSCLC 的患者进行了多机构回顾性分析。使用机器人手术系统，按照癌症和白血病组 B（CALGB）共识视频辅助胸腔镜手术（VATS）肺叶切除术技术进行机器人肺叶切除术。前瞻性记录围手术期结果和长期随访情况，自手术日期至末次随访计算生存情况。
2002 年 11 月至 2010 年 5 月，3 家机构共连续 325 例患者接受机器人肺叶切除术治疗早期 NSCLC。患者中位年龄为 66 岁（范围 30-87 岁），37%（120 例）为女性。大多数患者为临床 I 期（IA 期 247 例，IB 期 63 例）。转为开胸手术的转化率为 8%（27/325）。总发病率为 25.2%（82/325），主要并发症发生率为 3.7%（12/325）。住院期间死亡 1 例（0.3%），中位住院时间为 5 天（范围 2-28 天）。病理分期分布为 54%（176 例）IA 期，22%（72 例）IB 期，13%（41 例）IIA 期，5%（15 例）IIB 期，6%（21 例）IIIA 期。中位随访 27 个月，总 5 年生存率为 80%（95%置信区间[CI]为 73-88），按病理分期，IA 期为 91%（CI 为 83-99），IB 期为 88%（CI 为 77-98），所有 II 期患者为 49%（CI 为 24-74）。IIIA 期患者总 3 年生存率为 43%（CI 为 16-69）。
机器人肺叶切除术治疗早期 NSCLC 可获得较低的发病率和死亡率。特定阶段的长期生存率是可以接受的，与 VATS 和开胸手术的结果一致。
