Department of Cardiothoracic Surgery, Heart Vascular and Thoracic Institute, and Taussig Cancer Institute, Cleveland Clinic Foundation.
Department of Cardiothoracic Surgery, Heart Vascular and Thoracic Institute, and Taussig Cancer Institute, Cleveland Clinic Foundation.
Ann Thorac Surg. 2020 Aug;110(2):424-433. doi: 10.1016/j.athoracsur.2020.02.059. Epub 2020 Mar 30.
Appropriate nodal dissection during pulmonary resection improves pathologic staging accuracy. Detection of unexpected nodal metastases can be a surrogate for nodal dissection adequacy and reflect oncologic resection quality. The goal of this study was to determine whether robotic lobectomy carries worse, same, or better incidence of nodal upstaging as open lobectomy for clinical stage I non-small cell lung cancer (NSCLC).
Data for patients with clinical stage I NSCLC (≤cT2a N0 M0, American Joint Committee on Cancer, 7th Edition) who underwent lobectomy from 2010 through 2015 were abstracted from the National Cancer Database (NCDB). Propensity score matching was performed for robotic (n = 7452) and open (n = 50,186) approaches. Primary outcomes were the number of lymph nodes examined and incidence of nodal upstaging, defined as unexpected hilar or mediastinal lymph node involvement. Secondary outcomes included resection margins and overall survival.
Matching generated 7452 well-matched pairs. There were no differences in nodal upstaging between robotic and open procedures (820 [11.0%] vs 863 [11.6%], P = .28), despite more examined lymph nodes in the robotic group (10 vs 8, P < .001). Incidence of positive margins (145 [2.0%] vs 178 [2.4%], P = .071) was similar. The robotic group had lower 30-day (73 [1.3%] vs 105 [1.9%], P = .02) and 90-day mortality (125 [2.3%] vs 188 [3.5%], P < .001). The 5-year overall survival was similar between both groups (65.6% vs 66.7%, log-rank P = .25).
Robotic lobectomy for clinical stage I NSCLC is an equivalent to open lobectomy as assessed by similar nodal upstaging rates, completeness of resection, and overall survival. This suggests that the robotic technology has been adopted appropriately in early-stage NSCLC.
在肺切除术中进行适当的淋巴结清扫可提高病理分期的准确性。意外淋巴结转移的检出可作为淋巴结清扫充分性的替代指标，并反映肿瘤切除质量。本研究旨在确定对于临床 I 期非小细胞肺癌（NSCLC），机器人肺叶切除术的淋巴结升级发生率是否比开胸肺叶切除术更差、相同或更好。
从国家癌症数据库（NCDB）中提取 2010 年至 2015 年间接受肺叶切除术的临床 I 期 NSCLC（≤cT2a N0 M0，美国癌症联合委员会，第 7 版）患者的数据。对机器人（n=7452）和开胸（n=50186）方法进行倾向评分匹配。主要结局为检查的淋巴结数量和淋巴结升级发生率，定义为意外的肺门或纵隔淋巴结受累。次要结局包括切缘和总生存。
匹配生成了 7452 对匹配良好的患者。机器人组和开胸组的淋巴结升级发生率无差异（820[11.0%]与 863[11.6%]，P=0.28），尽管机器人组检查的淋巴结更多（10 与 8，P<0.001）。阳性切缘的发生率（145[2.0%]与 178[2.4%]，P=0.071）相似。机器人组的 30 天死亡率（73[1.3%]与 105[1.9%]，P=0.02）和 90 天死亡率（125[2.3%]与 188[3.5%]，P<0.001）均较低。两组的 5 年总生存率相似（65.6%与 66.7%，对数秩 P=0.25）。
在临床 I 期 NSCLC 中，机器人肺叶切除术与开胸肺叶切除术相当，其淋巴结升级率、切除完整性和总生存率相似。这表明在早期 NSCLC 中，机器人技术已得到适当采用。
