Shahin Ghada M, Topal Besir, Pouwels Sjaak, Markou Thanasie L, Boon Rody, Stigt Jos A
Department of Cardiothoracic Surgery, Isala Heart Center, Zwolle, The Netherlands.
Department of Intensive Care, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands.
J Thorac Dis. 2021 Feb;13(2):592-599. doi: 10.21037/jtd-20-2267.
Robot assisted thoracic surgery (RATS) is the minimally invasive surgical technique of choice for treatment of patients with non-small cell lung cancer (NSCLC), at the Isala Hospital. The aim of this study is to compare clinical and pathological staging results and mediastinal recurrence after RATS for anatomical resections of lung cancer as surrogate markers for quality of mediastinal lymph node dissection (MLND).
This single institute retrospective study was conducted in patients who underwent RATS for NSCLC. Excluded were patients with a history of concurrent malignant disease, with other previous neoplasms, with small cell lung cancer (SCLC) and patients in whom the robotic technique was converted to thoracotomy, prior to lymph node dissection. Data were obtained from the hospital database. The difference between clinical and pathological staging was expressed as upstaging and downstaging. Computed Tomography scanning was used for follow-up, and diagnosis of mediastinal recurrence.
From November 2011 to May 2016, 227 patients underwent RATS at Isala Hospital Zwolle, the Netherlands. Of those, 130 (mean age, 69.5±9.3 years) met the eligibility criteria. Preoperative mediastinal lymph node staging was done by endoscopic ultrasound/endobronchial ultrasound, by positron emission tomography (PET) or mediastinoscopy. In 14 patients (10.8%) unforeseen N2 disease was found, 6 patients (4.6%) were upstaged from cN0 to pN2 and 8 patients (6.2%) were upstaged from cN1 to pN2. Mediastinal recurrence was detected in 7 patients (5.4%) during a median follow-up of 54 months (range, 1.5-102 months).
In patients with NSCLC, who underwent anatomical resection by means of RATS, an unforeseen N2 disease rate of 10.8% was demonstrated and a mediastinal recurrence rate of 5.4%. It is concluded that robotic surgery provides an accurate lymph node dissection.
在伊萨拉医院，机器人辅助胸腔镜手术（RATS）是治疗非小细胞肺癌（NSCLC）患者的首选微创手术技术。本研究的目的是比较RATS用于肺癌解剖性切除术后的临床和病理分期结果以及纵隔复发情况，以此作为纵隔淋巴结清扫（MLND）质量的替代指标。
本单中心回顾性研究纳入了接受RATS治疗NSCLC的患者。排除有并发恶性疾病史、既往有其他肿瘤、小细胞肺癌（SCLC）以及在淋巴结清扫前机器人技术转为开胸手术的患者。数据来自医院数据库。临床分期与病理分期的差异用分期上调和分期下调表示。采用计算机断层扫描进行随访及纵隔复发的诊断。
2011年11月至2016年5月，荷兰兹沃勒伊萨拉医院有227例患者接受了RATS手术。其中，130例（平均年龄69.5±9.3岁）符合纳入标准。术前通过内镜超声/支气管内超声、正电子发射断层扫描（PET）或纵隔镜进行纵隔淋巴结分期。发现14例（10.8%）患者存在意外的N2期疾病，6例（4.6%）患者从cN0上调为pN2，8例（6.2%）患者从cN1上调为pN2。在中位随访54个月（范围1.5 - 102个月）期间，7例（5.4%）患者检测到纵隔复发。
在接受RATS进行解剖性切除的NSCLC患者中，意外N2期疾病发生率为10.8%，纵隔复发率为5.4%。得出结论，机器人手术可实现准确的淋巴结清扫。
