Zhou Qianjun, Huang Jia, Pan Feng, Li Jiantao, Liu Yuan, Hou Yucheng, Song Weijian, Luo Qingquan
Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China.
Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China.
Transl Lung Cancer Res. 2020 Apr;9(2):306-315. doi: 10.21037/tlcr-20-533.
Robotic anatomic segmentectomy (RATS) for early-stage lung cancer is being increasingly performed in spite of limited published evidence. To evaluate its safety and oncologic efficacy, we compared the outcomes of both RATS and video-assisted thoracoscopic (VATS) segmentectomy in patients with small-sized (<2 cm) peripheral stage IA lung cancer.
From November 2011 to January 2018, a total of 130 patients with resected stage IA non-small cell lung cancer (NSCLC) who underwent RATS (n=50) and VATS (n=80) pulmonary segmentectomy were included. Clinicopathologic data, recurrence rate, and survival were recorded.
The demographics, pulmonary function, comorbidity, and tumor size were similar between RATS segmentectomy and VATS segmentectomy. The surgery time, intensive care unit stay, hospital stay, and blood loss were reduced in the RATS group compared to the VATS group. The number of totally dissected lymph nodes and postoperative complications were similar between the 2 groups. There was no operative mortality. The intensity of narcotic use during hospital stay and the time to return to routine daily activities were also reduced in the RATS group. There was no recurrence observed in the RATS group during the median 38-month follow-up period; meanwhile, during a median 85-month follow-up period in the VATS group, local recurrence and distant recurrence was observed in 2 patients (2.5%) and 3 patients (3.75%) respectively. There was no significant difference in the 5-year recurrence-free survival between the RATS and VATS groups (100% 93.75%; P>0.05).
RATS can be performed safely and effectively in patients with early-stage NSCLC. The reduced narcotic use and earlier return to routine daily activities of RATS patients might reflect its less traumatic nature as compared to VATS. For stage IA disease with small tumors (<2 cm), segmentectomy performed by RATS has better oncologic efficacy when compared to VATS, although in this study, this difference did not reach statistical difference.
尽管已发表的证据有限，但机器人解剖性肺段切除术（RATS）用于早期肺癌的手术仍越来越多。为评估其安全性和肿瘤学疗效，我们比较了RATS和电视辅助胸腔镜（VATS）肺段切除术治疗小尺寸（<2 cm）外周型IA期肺癌患者的疗效。
纳入2011年11月至2018年1月期间共130例行RATS（n = 50）和VATS（n = 80）肺段切除术的IA期非小细胞肺癌（NSCLC）患者，记录其临床病理数据、复发率和生存率。
RATS肺段切除术和VATS肺段切除术患者的人口统计学特征、肺功能、合并症和肿瘤大小相似。与VATS组相比，RATS组的手术时间、重症监护病房停留时间、住院时间和失血量均减少。两组完全清扫的淋巴结数量和术后并发症相似，无手术死亡。RATS组住院期间的麻醉药物使用强度和恢复日常活动的时间也减少。RATS组在中位38个月的随访期内未观察到复发；同时，VATS组在中位85个月的随访期内，分别有2例患者（2.5%）出现局部复发，3例患者（3.75%）出现远处复发。RATS组和VATS组的5年无复发生存率无显著差异（100%对93.75%；P>0.05）。
RATS可安全有效地应用于早期NSCLC患者。RATS患者麻醉药物使用减少且能更早恢复日常活动，这可能反映出与VATS相比，其创伤性较小。对于肿瘤较小（<2 cm）的IA期疾病，与VATS相比，RATS进行的肺段切除术具有更好的肿瘤学疗效，尽管在本研究中，这种差异未达到统计学意义。
