机器人辅助肺叶切除术与电视辅助胸腔镜手术治疗IIB-IIIA期非小细胞肺癌的比较。
Comparison of robotic-assisted lobectomy with video-assisted thoracic surgery for stage IIB-IIIA non-small cell lung cancer.
作者信息
Li Chongwu, Hu Yingjie, Huang Jia, Li Jiantao, Jiang Long, Lin Hao, Lu Peiji, Luo Qingquan
机构信息
Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China.
出版信息
Transl Lung Cancer Res. 2019 Dec;8(6):820-828. doi: 10.21037/tlcr.2019.10.15.
BACKGROUND
With the rapid development of surgical technics and instruments, more and more locally advanced non-small cell lung cancer (NSCLC) patients are being treated by minimally invasive surgery (MIS), including video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS). The aim of this retrospective study was to compare the perioperative and long-term outcomes of patients who underwent lobectomy by these two surgical approaches.
METHODS
We performed a retrospective review of the prospectively collected database of our hospital to identify patients with clinical stage IIB-IIIA NSCLC who underwent video-assisted thoracoscopic or robotic lobectomy. Perioperative outcomes, recurrence, and overall survival (OS) were compared.
RESULTS
From January 2014 to January 2017, there were at total of 121 patients, including 36 robotic lobectomy patients and 85 VATS lobectomy patients. One patient (2.8%) in the RATS group and 5 patients (5.9%) in the VATS group were converted to thoracotomy (P=0.79). No perioperative death was observed in both groups. The postoperative morbidity was similar between the two groups (13.9% for RATS 15.3% for VATS; P=0.84). Robotic lobectomy was associated with a shorter length of postoperative hospital stay (4 5 d, P<0.01) and more counts of lymph nodes harvested (13 10, P<0.01). The median disease-free survival (DFS) for the RATS and VATS groups were 31.1 and 33.8 months, respectively. The corresponding 3-year DFS was 40.3% in the RATS group and 47.6% in the VATS group (P=0.74). The 3-year OS was 75.7% in RATS and 77.0% in the VATS group (P=0.75).
CONCLUSIONS
For selected NSCLC patients with lymph node involvement, robotic lobectomy is safe and effective with a low complication rate and similar long-term outcome compared with VATS lobectomy. Moreover, the robotic approach resulted in shorter postoperative length of stay and greater lymph node assessment.
背景
随着手术技术和器械的快速发展，越来越多的局部晚期非小细胞肺癌（NSCLC）患者接受微创手术（MIS）治疗，包括电视辅助胸腔镜手术（VATS）和机器人辅助胸腔镜手术（RATS）。本回顾性研究的目的是比较采用这两种手术方式行肺叶切除术患者的围手术期和长期结局。
方法
我们对我院前瞻性收集的数据库进行回顾性分析，以确定接受电视辅助胸腔镜或机器人辅助肺叶切除术的临床IIB-IIIA期NSCLC患者。比较围手术期结局、复发情况和总生存期（OS）。
结果
2014年1月至2017年1月，共有121例患者，其中36例行机器人辅助肺叶切除术，85例行VATS肺叶切除术。RATS组1例患者（2.8%）和VATS组5例患者（5.9%）中转开胸手术（P = 0.79）。两组均未观察到围手术期死亡。两组术后发病率相似（RATS组为13.9%，VATS组为15.3%；P = 0.84）。机器人辅助肺叶切除术与术后住院时间较短（4对5天，P < 0.01）和清扫淋巴结数量较多（13对10，P < 0.01）相关。RATS组和VATS组的中位无病生存期（DFS）分别为31.1个月和33.8个月。相应的3年DFS在RATS组为40.3%，在VATS组为47.6%（P = 0.74）。3年OS在RATS组为75.7%，在VATS组为77.0%（P = 0.75）。
结论
对于选定的有淋巴结转移的NSCLC患者，机器人辅助肺叶切除术安全有效，并发症发生率低，与VATS肺叶切除术相比长期结局相似。此外，机器人手术方式导致术后住院时间更短，淋巴结评估更多。
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