Novellis Pierluigi, Bottoni Edoardo, Voulaz Emanuele, Cariboni Umberto, Testori Alberto, Bertolaccini Luca, Giordano Laura, Dieci Elisa, Granato Lorenzo, Vanni Elena, Montorsi Marco, Alloisio Marco, Veronesi Giulia
Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy.
J Thorac Dis. 2018 Feb;10(2):790-798. doi: 10.21037/jtd.2018.01.123.
Robotic surgery is increasingly used to resect lung cancer. However costs are high. We compared costs and outcomes for robotic surgery, video-assisted thoracic surgery (VATS), and open surgery, to treat non-small cell lung cancer (NSCLC).
We retrospectively assessed 103 consecutive patients given lobectomy or segmentectomy for clinical stage I or II NSCLC. Three surgeons could choose VATS or open, the fourth could choose between all three techniques. Between-group differences were assessed by Fisher's exact, two-way analysis of variance (ANOVA), and Wilcoxon-Mann-Whitney test. P values <0.05 were considered significant.
Twenty-three patients were treated by robot, 41 by VATS, and 39 by open surgery. Age, physical status, pulmonary function, comorbidities, stage, and perioperative complications did not differ between the groups. Pathological tumor size was greater in the open than VATS and robotic groups (P=0.025). Duration of surgery was 150, 191 and 116 minutes, by robotic, VATS and open approaches, respectively (P<0.001). Significantly more lymph node stations were removed (P<0.001), and median length of stay was shorter (4, 5 and 6 days, respectively; P<0.001) in the robotic than VATS and open groups. Estimated costs were 82%, 68% and 69%, respectively, of the regional health service reimbursement for robotic, VATS and open approaches.
Robotic surgery for early lung cancer was associated with shorter stay and more extensive lymph node dissection than VATS and open surgery. Duration of surgery was shorter for robotic than VATS. Although the cost of robotic thoracic surgery is high, the hospital makes a profit.
机器人手术越来越多地用于肺癌切除术。然而，成本很高。我们比较了机器人手术、电视辅助胸腔镜手术（VATS）和开放手术治疗非小细胞肺癌（NSCLC）的成本和结果。
我们回顾性评估了103例连续接受肺叶切除术或肺段切除术治疗临床I期或II期NSCLC的患者。三位外科医生可以选择VATS或开放手术，第四位医生可以在所有三种技术之间进行选择。组间差异通过Fisher精确检验、双向方差分析（ANOVA）和Wilcoxon-Mann-Whitney检验进行评估。P值<0.05被认为具有统计学意义。
23例患者接受机器人手术治疗，41例接受VATS治疗，39例接受开放手术治疗。各组之间的年龄、身体状况、肺功能、合并症、分期和围手术期并发症无差异。开放手术组的病理肿瘤大小大于VATS组和机器人手术组（P=0.025）。机器人手术、VATS手术和开放手术的手术时间分别为150分钟、191分钟和116分钟（P<0.001）。机器人手术组切除的淋巴结站显著更多（P<0.001），中位住院时间更短（分别为4天、5天和6天；P<0.001），而VATS组和开放手术组。机器人手术、VATS手术和开放手术的估计成本分别为地区卫生服务报销费用的8..68%和69%。
早期肺癌的机器人手术与VATS和开放手术相比，住院时间更短，淋巴结清扫范围更广。机器人手术的手术时间比VATS短。虽然机器人胸外科手术的成本很高，但医院仍有盈利。
