Division of Cardiothoracic Surgery, The University of Arizona Medical Center, Tucson, AZ, USA.
Global Robotics Institute, Florida Hospital Celebration Health and University of Central Florida, Orlando, FL, USA.
Eur J Cardiothorac Surg. 2019 Mar 1;55(3):427-433. doi: 10.1093/ejcts/ezy332.
Anatomical segmentectomy is advocated for curative resection in select patients. We investigated the long-term results of robotic anatomical segmentectomy with mediastinal nodal dissection in patients with early-stage lung cancer.
We retrospectively reviewed patients who underwent robotic anatomical segmentectomy for early-stage non-small-cell lung cancer (NSCLC). The follow-up data were obtained to determine survival and statistically significant risk factors in both univariable and multivariable models.
Seventy-one patients had clinical stage I NSCLC (36 men, 35 women, mean age 70 ± 12 years). All patients underwent R0 resection. The mean operating time was 134 min. Ten of 71 (14%) patients were upstaged. Eight of 71 (11%) patients were upstaged due to the size of tumour in the pathological specimen, and 2 of 71 (3%) patients were upstaged due to microscopic N2 nodal metastasis. Median hospitalization was 4 days (2-31 days). Complication rate was 29%. There were no complications attributable to the surgical robot. No patient died within 90 days. Mean follow-up was 54 months (range 2 months to 9 years). The overall 5-year survival was 43%, whereas lung cancer-specific 5-year survival was 55%. The 5-year lung cancer-specific survival for pathological stage I disease was 73%. Local or mediastinal recurrence occurred in 4 of 71(5%) patients. Pathological upstaging or recurrence resulted in 0% 5-year survival. The univariable and multivariable analyses showed that advanced age and pathological upstaging were statistically significant risk factors for lung cancer-specific death.
Robotic anatomical segmentectomy with mediastinal nodal dissection is a safe and feasible procedure. Accurate preoperative clinical staging is of critical importance for long-term survival.
解剖性肺段切除术被提倡用于选择性患者的根治性切除。我们研究了机器人解剖性肺段切除术联合纵隔淋巴结清扫术治疗早期肺癌患者的长期结果。
我们回顾性分析了接受机器人解剖性肺段切除术治疗早期非小细胞肺癌（NSCLC）的患者。获取随访数据以确定生存情况，并在单变量和多变量模型中确定统计学显著的危险因素。
71 例患者患有临床 I 期 NSCLC（36 例男性，35 例女性，平均年龄 70±12 岁）。所有患者均行 R0 切除。平均手术时间为 134 分钟。71 例患者中有 10 例（14%）分期升高。71 例患者中有 8 例（11%）因病理标本中肿瘤大小而分期升高，2 例（3%）因显微镜下 N2 淋巴结转移而分期升高。中位住院时间为 4 天（2-31 天）。并发症发生率为 29%。无与手术机器人相关的并发症。90 天内无患者死亡。平均随访时间为 54 个月（2 个月至 9 年）。总 5 年生存率为 43%，而肺癌特异性 5 年生存率为 55%。I 期病理疾病的 5 年肺癌特异性生存率为 73%。71 例患者中有 4 例（5%）出现局部或纵隔复发。病理分期升高或复发导致 0%的 5 年生存率。单变量和多变量分析显示，高龄和病理分期升高是肺癌特异性死亡的统计学显著危险因素。
机器人解剖性肺段切除术联合纵隔淋巴结清扫术是一种安全可行的方法。准确的术前临床分期对长期生存至关重要。
