Sarkaria Inderpal S, Gorrepati Madhu Lalitha, Mehendale Shilpa, Oh Daniel S
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Clinical Affairs, Intuitive Surgical, Inc., Sunnyvale, CA, USA.
J Thorac Dis. 2019 Jun;11(6):2420-2430. doi: 10.21037/jtd.2019.05.52.
The proportion of the elderly (≥80 years old) patient population in the United States is increasing. Consequently, surgeons are more involved in the care of these patients than they had been in the past. Therefore, surgeons must re-evaluate their prior assumptions about their surgical management of octogenarian patients. Although open thoracotomy is a popular approach for pulmonary lobectomy, minimally invasive techniques are associated with improved outcomes in this frail patient population. Our goal was to evaluate perioperative outcomes of standard open lobectomy to both video-assisted thoracoscopic and robotic-assisted lobectomy in patients ≥80 years old.
Octogenarian patients, who underwent elective pulmonary lobectomy from January 1, 2011 through September 30, 2015, were identified from the National Premier Healthcare Database. One-to-one propensity score matching (PSM) was performed between robotic-assisted and open lobectomy populations and between video-assisted thoracoscopic and open lobectomy populations. Rates of perioperative outcomes from each comparison were analyzed.
Of the 1,849 octogenarian patients who satisfied the inclusion criteria, propensity-score matched (1:1) comparative analyses of robotic-assisted lobectomy (n=232) and open lobectomy (n=232) patients as well as video-assisted thoracoscopic lobectomy (n=562) and open lobectomy (n=562) patients were made. Both robotic-assisted and video-assisted thoracoscopic lobectomy cohorts were associated with shorter lengths of stay (both P<0.001) and higher rates of discharge to home compared to open lobectomy (P=0.0435 and P=0.0037, respectively). Robotic-assisted lobectomy was associated with fewer postoperative complications compared to open lobectomy (P=0.0249).
Minimally invasive lobectomy is a viable surgical option in octogenarians and provides improved outcomes compared to open thoracotomy in a retrospective cohort. Carefully selected patients can achieve excellent outcomes.
美国老年（≥80岁）患者群体的比例正在增加。因此，外科医生比过去更多地参与到这些患者的护理中。所以，外科医生必须重新评估他们之前对老年患者手术管理的假设。尽管开胸手术是肺叶切除术的常用方法，但在这个脆弱的患者群体中，微创技术与更好的治疗效果相关。我们的目标是评估≥80岁患者接受标准开胸肺叶切除术与电视辅助胸腔镜肺叶切除术和机器人辅助肺叶切除术的围手术期结果。
从国家优质医疗数据库中识别出2011年1月1日至2015年9月30日期间接受择期肺叶切除术的老年患者。在机器人辅助肺叶切除术组与开胸肺叶切除术组之间以及电视辅助胸腔镜肺叶切除术组与开胸肺叶切除术组之间进行一对一倾向评分匹配（PSM）。分析每组比较的围手术期结果发生率。
在1849名符合纳入标准的老年患者中，对机器人辅助肺叶切除术（n = 232）与开胸肺叶切除术（n = 232）患者以及电视辅助胸腔镜肺叶切除术（n = 562）与开胸肺叶切除术（n = 562）患者进行了倾向评分匹配（1:1）的比较分析。与开胸肺叶切除术相比，机器人辅助肺叶切除术组和电视辅助胸腔镜肺叶切除术组的住院时间均较短（均P<0.001），出院回家的比例更高（分别为P = 0.0435和P = 0.0037）。与开胸肺叶切除术相比，机器人辅助肺叶切除术的术后并发症更少（P = 0.0249）。
在回顾性队列中，微创肺叶切除术是老年患者可行的手术选择，与开胸手术相比可提供更好的治疗效果。精心挑选的患者可取得优异的治疗效果。
