机器人辅助电视胸腔镜肺切除术的系统评价和荟萃分析。
A systematic review and meta-analysis on pulmonary resections by robotic video-assisted thoracic surgery.
机构信息
The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia; ; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia; ; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia.
出版信息
Ann Cardiothorac Surg. 2012 May;1(1):3-10. doi: 10.3978/j.issn.2225-319X.2012.04.03.
BACKGROUND
Pulmonary resection by robotic video-assisted thoracic surgery (RVATS) has been performed for selected patients in specialized centers over the past decade. Despite encouraging results from case-series reports, there remains a lack of robust clinical evidence for this relatively novel surgical technique. The present systematic review aimed to assess the short- and long-term safety and efficacy of RVATS.
METHODS
Nine relevant and updated studies were identified from 12 institutions using five electronic databases. Endpoints included perioperative morbidity and mortality, conversion rate, operative time, length of hospitalization, intraoperative blood loss, duration of chest drainage, recurrence rate and long-term survival. In addition, cost analyses and quality of life assessments were also systematically evaluated. Comparative outcomes were meta-analyzed when data were available.
RESULTS
All institutions used the same master-slave robotic system (da Vinci, Intuitive Surgical, Sunnyvale, California) and most patients underwent lobectomies for early-stage non-small cell lung cancers. Perioperative mortality rates for patients who underwent pulmonary resection by RVATS ranged from 0-3.8%, whilst overall morbidity rates ranged from 10-39%. Two propensity-score analyses compared patients with malignant disease who underwent pulmonary resection by RVATS or thoracotomy, and a meta-analysis was performed to identify a trend towards fewer complications after RVATS. In addition, one cost analysis and one quality of life study reported improved outcomes for RVATS when compared to open thoracotomy.
CONCLUSIONS
Results of the present systematic review suggest that RVATS is feasible and can be performed safely for selected patients in specialized centers. Perioperative outcomes including postoperative complications were similar to historical accounts of conventional VATS. A steep learning curve for RVATS was identified in a number of institutional reports, which was most evident in the first 20 cases. Future studies should aim to present data with longer follow-up, clearly defined surgical outcomes, and through an intention-to-treat analysis.
背景
在过去的十年中，在专业中心，通过机器人辅助电视胸腔镜手术（RVATS）已经为选定的患者进行了肺切除术。尽管来自病例系列报告的结果令人鼓舞，但这种相对较新的手术技术仍然缺乏强有力的临床证据。本系统评价旨在评估 RVATS 的短期和长期安全性和有效性。
方法
使用五个电子数据库，从 12 个机构中确定了 9 项相关且更新的研究。终点包括围手术期发病率和死亡率、转化率、手术时间、住院时间、术中出血量、胸腔引流时间、复发率和长期生存率。此外，还系统地评估了成本分析和生活质量评估。当有数据时，对比较结果进行了荟萃分析。
结果
所有机构均使用相同的主从式机器人系统（da Vinci，Intuitive Surgical，加利福尼亚州森尼韦尔），大多数患者接受了早期非小细胞肺癌的肺叶切除术。接受 RVATS 肺切除术的患者围手术期死亡率为 0-3.8%，而总发病率为 10-39%。两项倾向评分分析比较了接受 RVATS 或开胸手术的恶性疾病患者，荟萃分析显示 RVATS 后并发症发生率呈下降趋势。此外，一项成本分析和一项生活质量研究报告称，与开胸手术相比，RVATS 可改善结果。
结论
本系统评价的结果表明，在专业中心，对于选定的患者，RVATS 是可行且安全的。包括术后并发症在内的围手术期结果与传统 VATS 的历史记录相似。在一些机构报告中发现了 RVATS 的陡峭学习曲线，在最初的 20 例中最为明显。未来的研究应旨在提供具有更长随访时间、明确的手术结果以及意向治疗分析的数据。
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