Rajaram Ravi, Mohanty Sanjay, Bentrem David J, Pavey Emily S, Odell David D, Bharat Ankit, Bilimoria Karl Y, DeCamp Malcolm M
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.
Ann Thorac Surg. 2017 Apr;103(4):1092-1100. doi: 10.1016/j.athoracsur.2016.09.108. Epub 2017 Jan 18.
Robotic lobectomy has been described for non-small cell lung cancer (NSCLC). Our objectives were to (1) evaluate the use of robotic lobectomy over time, (2) identify factors associated with its use, and (3) assess outcomes after robotic lobectomy compared with other surgical approaches.
Stage I to IIIA NSCLC patients were identified from the National Cancer Data Base (2010 to 2012). Trends in robotic lobectomy were assessed over time, and multivariable logistic regression models were developed to identify factors associated with its use. Propensity-matched cohorts were constructed to compare postoperative outcomes after robotic lobectomy with thoracoscopic and open lobectomy.
Lobectomy was performed in 62,206 patients by open (n = 45,527), thoracoscopic (n = 12,990), or robotic (n = 3,689) procedures at 1,215 hospitals. Between 2010 and 2012, robotic lobectomy significantly increased, from 3.0% to 9.1% (p < 0.001). Academic (odds ratio, 1.55; 95% confidence interval, 1.04 to 2.33) and high-volume hospitals (odds ratio, 1.49; 95% confidence interval, 1.04 to 2.14) were associated with increased use of robotic lobectomy. Length of stay was shorter in robotic lobectomy compared with open lobectomy (6.1 vs 6.9 days; p < 0.001). Fewer lymph nodes (9.9 vs 10.9; p < 0.001) and 12 or more nodes were examined less frequently (32.0% vs 35.6%; p = 0.005) in robotic resections than in thoracoscopic resections. There was no difference between robotic and open or robotic and thoracoscopic lobectomy patients in margin positivity, 30-day readmission, and deaths at 30 and 90 days.
Robotic lobectomies have significantly increased in stage I to IIIA NSCLC patients, with outcomes similar to other approaches. Additional studies are needed to determine if this technology offers potential advantages compared with video-assisted thoracoscopic operations.
机器人辅助肺叶切除术已应用于非小细胞肺癌（NSCLC）的治疗。我们的目标是：（1）评估机器人辅助肺叶切除术随时间的使用情况；（2）确定与该手术使用相关的因素；（3）评估机器人辅助肺叶切除术后与其他手术方式相比的疗效。
从国家癌症数据库（2010 - 2012年）中识别出I至IIIA期NSCLC患者。评估机器人辅助肺叶切除术随时间的趋势，并建立多变量逻辑回归模型以确定与该手术使用相关的因素。构建倾向匹配队列，比较机器人辅助肺叶切除术与胸腔镜肺叶切除术和开胸肺叶切除术后的术后疗效。
在1215家医院，62206例患者接受了肺叶切除术，手术方式包括开胸手术（n = 45527）、胸腔镜手术（n = 12990）或机器人辅助手术（n = 3689）。2010年至2012年期间，机器人辅助肺叶切除术显著增加，从3.0%增至9.1%（p < 0.001）。学术型医院（优势比，1.55；95%置信区间，1.04至2.33）和高容量医院（优势比，1.49；95%置信区间，1.04至2.14）与机器人辅助肺叶切除术使用增加相关。与开胸肺叶切除术相比，机器人辅助肺叶切除术的住院时间更短（6.1天对6.9天；p < 0.001）。机器人辅助切除术检查的淋巴结数量少于胸腔镜切除术（9.9个对10.9个；p < 0.001），且检查12个或更多淋巴结的频率更低（32.0%对35.6%；p = 0.005）。机器人辅助肺叶切除术患者与开胸肺叶切除术患者或机器人辅助肺叶切除术患者与胸腔镜肺叶切除术患者在切缘阳性、30天再入院率以及30天和90天死亡率方面无差异。
I至IIIA期NSCLC患者中机器人辅助肺叶切除术显著增加，其疗效与其他手术方式相似。需要进一步研究以确定该技术与电视辅助胸腔镜手术相比是否具有潜在优势。
