Huang Jia, Li Chongwu, Li Hecheng, Lv Fanzhen, Jiang Long, Lin Hao, Lu Peiji, Luo Qingquan, Xu Wenrong
Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang xxxx, China.
Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai xxxx, China.
Transl Lung Cancer Res. 2019 Dec;8(6):951-958. doi: 10.21037/tlcr.2019.11.31.
Safety and short-term efficacy of robot-assisted thoracoscopic surgery (RATS) for early-stage non-small cell lung cancer (NSCLC) have been previously proven; however, RATS for N2 stage NSCLC was barely evaluated. The aim of this randomized controlled trial (RCT) was to explore the short-term outcome of RATS for cN2 stage NSCLC.
Total of 113 patients who were diagnosed with clinically single cN2 stage NSCLC were enrolled and randomly assigned to RATS and thoracotomy groups. The patients in RATS group were treated by lobectomy and mediastinal lymph node dissection using the da Vinci Surgical System, while the patients in thoracotomy group underwent lobectomy and mediastinal lymph node dissection from. And, short-term outcomes were analyzed statistically.
The data from 108 subjects (58 in RATS and 55 in thoracotomy groups) were eligible for analyses. Five patients who received robot-assisted lobectomy initially was converted intraoperatively to open operation due to extensive pleural adhesion and equipment issues. And, one subject underwent robot-assisted surgery was died preoperatively due to pulmonary embolism. Compared with thoracotomy, RATS was associated with less intraoperative blood loss (86.3±41.1 . 165.7±46.4 mL, P<0.001), median chest duration (4 . 5, P<0.01), visual analog scores at postoperative day one to five (P<0.001), and slightly fewer incidence of postoperative complications. Also, both surgical approaches revealed comparable drainages and nodal harvest. The cancer residual margins occurred in one subject in RATS group and three patients in thoracotomy group (P=0.56). However, overall cost of subjects underwent RATS was higher than those received thoracotomy (100,367±19,251 82,002±20,434, P<0.001).
Present study proves that the feasibility and safety of RATS lobectomy to treat patients with cN2 stage NSCLC, and it should be superior to thoracotomy due to lesser intraoperative blood loss.
机器人辅助胸腔镜手术（RATS）治疗早期非小细胞肺癌（NSCLC）的安全性和短期疗效已得到证实；然而，RATS治疗N2期NSCLC的情况几乎未被评估。本随机对照试验（RCT）的目的是探讨RATS治疗cN2期NSCLC的短期疗效。
共纳入113例临床诊断为单发cN2期NSCLC的患者，并随机分为RATS组和开胸组。RATS组患者使用达芬奇手术系统行肺叶切除术和纵隔淋巴结清扫术，而开胸组患者行肺叶切除术和纵隔淋巴结清扫术。对短期疗效进行统计学分析。
108例受试者（RATS组58例，开胸组55例）的数据符合分析要求。5例最初接受机器人辅助肺叶切除术的患者因广泛胸膜粘连和设备问题术中转为开放手术。1例接受机器人辅助手术的受试者术前因肺栓塞死亡。与开胸手术相比，RATS手术术中出血量更少（86.3±41.1对165.7±46.4 mL，P<0.001），中位胸腔引流时间更短（4对5，P<0.），术后第1至5天视觉模拟评分更低（P<0.001），术后并发症发生率略低。此外，两种手术方式的引流量和淋巴结清扫数量相当。RATS组有1例患者切缘癌残留，开胸组有3例患者切缘癌残留（P=0.56）。然而，接受RATS手术的受试者总体费用高于接受开胸手术的受试者（100,367±19,251对82,002±20,434，P<0.001）。
本研究证明RATS肺叶切除术治疗cN2期NSCLC患者的可行性和安全性，且由于术中出血量较少，应优于开胸手术。
