Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Department of Economics, Harvard University, Cambridge, Massachusetts.
Ann Thorac Surg. 2014 Jan;97(1):236-42; discussion 242-4. doi: 10.1016/j.athoracsur.2013.07.117. Epub 2013 Oct 1.
To date, reports on outcomes after robotic-assisted pulmonary resection have been confined to small, single-institution case series. Furthermore, no comparison has been made between robotic, open, and video-assisted thoracic surgery (VATS) procedures. We sought to compare the outcomes between these approaches using the State Inpatient Databases (SID).
Using the 2008 to 2010 SID, we identified patients who underwent an open, VATS, or robotic lobectomy from 8 states. Patients who underwent segmentectomy were also included. A comparison of outcomes was performed using a propensity-matched analysis.
We identified a total of 33,095 patients (open: 20,238; VATS: 12,427; robotic: 430). Case volumes for robotic resections increased over the study period from 0.2% in 2008 to 3.4% in 2010. Robotic resections were performed in all 8 states, and 38% were conducted in a community hospital. In propensity-matched analysis, robotic resections were associated with significant reductions in mortality (0.2% vs 2.0%, p = 0.016), length of stay (5.9 vs 8.2 days, p < 0.0001), and overall complication rates (43.8% vs 54.1%, p = 0.003) when compared with open thoracotomy. Robotic resection was also associated with reductions in mortality (0.2% vs 1.1%, p = 0.12), length of stay (5.9 days vs 6.3 days, p = 0.45), and overall complication rates (43.8% vs 45.3%, p = 0.68) when compared with VATS; however, none of these differences were statistically significant.
Case volume for robotic pulmonary resections has increased significantly during the study period, and thoracic surgeons have been able to adopt the robotic approach safely. Robotic resection appears to be an appropriate alternative to VATS and is associated with improved outcomes compared with open thoracotomy.
迄今为止，有关机器人辅助肺切除术结果的报告仅限于小型的单一机构病例系列。此外，尚未对机器人手术、开胸手术和电视辅助胸腔镜手术（VATS）进行比较。我们试图使用州住院数据库（SID）比较这些方法的结果。
使用 2008 年至 2010 年的 SID，我们从 8 个州确定了接受开胸、VATS 或机器人肺叶切除术的患者。还包括接受节段切除术的患者。使用倾向匹配分析比较了结果。
我们共确定了 33095 例患者（开胸：20238 例；VATS：12427 例；机器人：430 例）。在研究期间，机器人切除术的病例量从 2008 年的 0.2%增加到 2010 年的 3.4%。机器人切除术在所有 8 个州均有开展，其中 38%在社区医院进行。在倾向匹配分析中，与开胸手术相比，机器人切除术显著降低了死亡率（0.2%比 2.0%，p = 0.016）、住院时间（5.9 天比 8.2 天，p < 0.0001）和总体并发症发生率（43.8%比 54.1%，p = 0.003）。与 VATS 相比，机器人切除术也降低了死亡率（0.2%比 1.1%，p = 0.12）、住院时间（5.9 天比 6.3 天，p = 0.45）和总体并发症发生率（43.8%比 45.3%，p = 0.68）；然而，这些差异均无统计学意义。
在研究期间，机器人肺切除术的病例量显著增加，胸外科医生能够安全地采用机器人方法。机器人切除术似乎是 VATS 的一种合适替代方法，与开胸手术相比，其结果得到了改善。
