欧洲多机构开展机器人辅助胸腺瘤切除术的经验
Multi-institutional European experience of robotic thymectomy for thymoma.
作者信息
Marulli Giuseppe, Maessen Jos, Melfi Franca, Schmid Thomas A, Keijzers Marlies, Fanucchi Olivia, Augustin Florian, Comacchio Giovanni M, Mussi Alfredo, Hochstenbag Monique, Rea Federico
机构信息
1 Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Italy ; 2 Department of Cardiothoracic Surgery, University Medical Centre of Maastricht, Netherlands ; 3 Department of Cardiac, Thoracic and Vascular Surgery, Thoracic Surgery Division, University of Pisa, Italy ; 4 Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Austria.
出版信息
Ann Cardiothorac Surg. 2016 Jan;5(1):18-25. doi: 10.3978/j.issn.2225-319X.2015.08.13.
BACKGROUND
Robotic thymectomy for early-stage thymomas has been recently suggested as a technically sound and safe approach. However, due to a lack of data on long term results, controversy still exists regarding its oncological efficacy. In this multi-institutional series collected from four European Centres with high volumes of robotic procedures, we evaluate the results after robot-assisted thoracoscopic thymectomy for thymoma.
METHODS
Between 2002 and 2014, 134 patients (61 males and 73 females, median age 59 years) with a clinical diagnosis of thymoma were operated on using a left-sided (38%), right-sided (59.8%) or bilateral (2.2%) robotic approach. Seventy (52%) patients had associated myasthenia gravis (MG).
RESULTS
The average operative time was 146 minutes (range, 60-353 minutes). Twelve (8.9%) patients needed open conversion: in one case, a standard thoracoscopy was performed after robotic system breakdown, and in six cases, an additional access was required. Neither vascular and nerve injuries, nor perioperative mortality occurred. A total of 23 (17.1%) patients experienced postoperative complications. Median hospital stay was 4 days (range, 2-35 days). Mean diameter of resected tumors was 4.4 cm (range, 1-10 cm), Masaoka stage was I in 46 (34.4%) patients, II in 71 (52.9%), III in 11 (8.3%) and IVa/b in 6 (4.4%) cases. At last follow up, 131 patients were alive, three died (all from non-thymoma related causes) with a 5-year survival rate of 97%. One (0.7%) patient experienced a pleural recurrence.
CONCLUSIONS
Our data suggest that robotic thymectomy for thymoma is a technically feasible and safe procedure with low complication rates and short hospital stays. Oncological outcome appears to be good, particularly for early-stage tumors, but a longer follow-up period and more cases are necessary in order to consider this as a standard approach. Indications for robotic thymectomy for stage III or IVa thymomas are rare and should be carefully evaluated.
背景
近期，机器人辅助胸腺切除术被认为是一种技术上可行且安全的早期胸腺瘤治疗方法。然而，由于缺乏长期结果数据，其肿瘤学疗效仍存在争议。在这个从四个欧洲高机器人手术量中心收集的多机构系列研究中，我们评估了机器人辅助胸腔镜胸腺切除术治疗胸腺瘤的结果。
方法
2002年至2014年间，134例临床诊断为胸腺瘤的患者（61例男性，73例女性，中位年龄59岁）接受了左侧（38%）、右侧（59.8%）或双侧（2.2%）机器人手术。70例（52%）患者合并重症肌无力（MG）。
结果
平均手术时间为146分钟（范围60 - 353分钟）。12例（8.9%）患者需要转为开放手术：1例在机器人系统故障后进行了标准胸腔镜手术，6例需要额外的手术入路。未发生血管和神经损伤，也无围手术期死亡。共有23例（17.1%）患者出现术后并发症。中位住院时间为4天（范围2 - 35天）。切除肿瘤的平均直径为4.4厘米（范围1 - 10厘米），Masaoka分期I期46例（34.4%），II期71例（52.9%），III期11例（8.3%），IVa/b期6例（4.4%）。在最后一次随访时，131例患者存活，3例死亡（均因非胸腺瘤相关原因），5年生存率为97%。1例（0.7%）患者出现胸膜复发。
结论
我们的数据表明，机器人辅助胸腺切除术治疗胸腺瘤在技术上可行且安全，并发症发生率低，住院时间短。肿瘤学结果似乎良好，尤其是对于早期肿瘤，但需要更长的随访期和更多病例才能将其视为标准方法。III期或IVa期胸腺瘤的机器人辅助胸腺切除术适应证罕见，应仔细评估。
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