Yang Chi-Fu Jeffrey, Sun Zhifei, Speicher Paul J, Saud Shakir M, Gulack Brian C, Hartwig Matthew G, Harpole David H, Onaitis Mark W, Tong Betty C, D'Amico Thomas A, Berry Mark F
Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
Department of Cell Biology and Molecular Medicine, New Jersey Medical School, Newark, New Jersey.
Ann Thorac Surg. 2016 Mar;101(3):1037-42. doi: 10.1016/j.athoracsur.2015.11.018. Epub 2016 Jan 26.
Previous studies have raised concerns that video-assisted thoracoscopic (VATS) lobectomy may compromise nodal evaluation. The advantages or limitations of robotic lobectomy have not been thoroughly evaluated.
Perioperative outcomes and survival of patients who underwent open versus minimally-invasive surgery (MIS [VATS and robotic]) lobectomy and VATS versus robotic lobectomy for clinical T1-2, N0 non-small cell lung cancer from 2010 to 2012 in the National Cancer Data Base were evaluated using propensity score matching.
Of 30,040 lobectomies, 7,824 were VATS and 2,025 were robotic. After propensity score matching, when compared with the open approach (n = 9,390), MIS (n = 9,390) was found to have increased 30-day readmission rates (5% versus 4%, p < 0.01), shorter median hospital length of stay (5 versus 6 days, p < 0.01), and improved 2-year survival (87% versus 86%, p = 0.04). There were no significant differences in nodal upstaging and 30-day mortality between the two groups. After propensity score matching, when compared with the robotic group (n = 1,938), VATS (n = 1,938) was not significantly different from robotics with regard to nodal upstaging, 30-day mortality, and 2-year survival.
In this population-based analysis, MIS (VATS and robotic) lobectomy was used in the minority of patients for stage I non-small cell lung cancer. MIS lobectomy was associated with shorter length of hospital stay and was not associated with increased perioperative mortality, compromised nodal evaluation, or reduced short-term survival when compared with the open approach. These results suggest the need for broader implementation of MIS techniques.
以往研究对电视辅助胸腔镜（VATS）肺叶切除术可能影响淋巴结评估提出了担忧。机器人辅助肺叶切除术的优势或局限性尚未得到充分评估。
利用倾向评分匹配法，对2010年至2012年美国国家癌症数据库中临床分期为T1-2、N0的非小细胞肺癌患者接受开胸手术与微创手术（MIS[VATS和机器人辅助手术]）肺叶切除术以及VATS与机器人辅助肺叶切除术的围手术期结局和生存率进行了评估。
在30040例肺叶切除术中，7824例为VATS手术，2025例为机器人辅助手术。倾向评分匹配后，与开胸手术组（n = 9390）相比，MIS组（n = 9390）的30天再入院率升高（5%对4%，p < 0.01），中位住院时间缩短（5天对6天，p < 0.01），2年生存率提高（87%对86%，p = 0.04）。两组在淋巴结分期升级和30天死亡率方面无显著差异。倾向评分匹配后，与机器人辅助手术组（n = 1938）相比，VATS组（n = 1938）在淋巴结分期升级、30天死亡率和2年生存率方面与机器人辅助手术组无显著差异。
在这项基于人群的分析中，I期非小细胞肺癌患者中少数采用了MIS（VATS和机器人辅助）肺叶切除术。与开胸手术相比，MIS肺叶切除术住院时间较短，且与围手术期死亡率增加、淋巴结评估受影响或短期生存率降低无关。这些结果表明需要更广泛地应用MIS技术。
