Gallagher Shea P, Abolhoda Amir, Kirkpatrick Vincent E, Saffarzadeh Areo G, Thein May S, Wilson Samuel E
University of Texas Health, San Antonio, San Antonia, TX USA.
Yale University School of Medicine, New Haven, CT USA.
Innovations (Phila). 2018 Sep/Oct;13(5):321-327. doi: 10.1097/IMI.0000000000000552.
The aim of the study was to characterize the clinical outcomes and learning curve during the adoption of a robotic platform for lobectomy for early-stage non-small cell lung cancer by a thoracic surgeon experienced in open thoracotomy.
Retrospective review of 157 consecutive patients (57 open thoracotomies, 100 robotic lobectomies) treated with lobectomy for clinical stage I or II non-small cell lung cancer between 2007 and 2014. Clinical outcomes were compared between the open thoracotomy group and five consecutive groups of 20 robotic lobectomies. We used the following six metrics to evaluate learning curve: operative time, conversion to open, estimated blood loss, hospitalization duration, overall morbidity, and pathologic nodal upstaging.
The robotic and open thoracotomy groups had equivalent preoperative characteristics, except for a higher proportion of clinical stage IA patients in the robotic cohort. The robotic group, as a whole, had lower intraoperative blood loss, less overall morbidity, shorter chest tube duration, and shorter length of hospital stay as compared with the open thoracotomy group. Operative time demonstrated a bimodal learning curve. Conversion rate diminished from 22.5% in the first two robotic groups to 6.7% in the latter three groups. The rate of pathologic nodal upstaging was statistically equivalent to the open thoracotomy group.
Adoption of a robotic platform for lobectomy for early-stage non-small cell lung cancer by an experienced open thoracic surgeon is safe and feasible, with fewer complications, less blood loss, and equivalent nodal sampling rate even during the learning curve. The conversion to open rate significantly dropped after the first 40 robotic lobectomies, and operative time for robotic lobectomy approached open thoracotomy after 60 cases, after a bimodal curve.
本研究旨在描述一名在开胸手术方面经验丰富的胸外科医生采用机器人平台进行早期非小细胞肺癌肺叶切除术的临床结果及学习曲线。
回顾性分析2007年至2014年间连续接受肺叶切除术治疗临床I期或II期非小细胞肺癌的157例患者（57例行开胸手术，100例行机器人辅助肺叶切除术）。将开胸手术组与连续五组每组20例机器人辅助肺叶切除术的患者的临床结果进行比较。我们使用以下六个指标来评估学习曲线：手术时间、转为开胸手术、估计失血量、住院时间、总体发病率和病理淋巴结分期上调。
机器人辅助手术组和开胸手术组术前特征相当，但机器人辅助手术队列中临床IA期患者比例较高。与开胸手术组相比，机器人辅助手术组总体术中失血量更少、总体发病率更低、胸管留置时间更短、住院时间更短。手术时间呈现双峰学习曲线。转换率从前两组机器人辅助手术组的22.5%降至后三组的6.7%。病理淋巴结分期上调率与开胸手术组在统计学上相当。
经验丰富的开胸外科医生采用机器人平台进行早期非小细胞肺癌肺叶切除术是安全可行的，即使在学习曲线期间并发症也较少、失血量更少且淋巴结采样率相当。在前40例机器人辅助肺叶切除术后，转为开胸手术的比例显著下降，在经历双峰曲线后于60例手术后机器人辅助肺叶切除术的手术时间接近开胸手术。
