1584247824 Division of Thoracic Surgery, University of Miami Hospital, FL, USA.
23457 Division of Thoracic Surgery, Memorial Healthcare System, South Broward, FL, USA.
Innovations (Phila). 2021 May-Jun;16(3):280-287. doi: 10.1177/1556984521997805. Epub 2021 Apr 18.
The use of segmentectomy for peripheral T ≤2 cm, N0 non-small cell lung cancer (NSCLC) has increased in the last decade. We sought to compare clinical outcomes and overall survival between robotic, video-assisted thoracoscopic surgery (VATS), and open segmentectomy.
The National Cancer Database was queried for patients with clinical T ≤2 cm, N0 NSCLC who underwent segmentectomy via robotic, thoracoscopic (VATS), and open approaches (2010 to 2015). Univariate and Cox regression analyses were used to compare surgical approaches and to evaluate predictors of overall survival. Statistical analyses were done using SPSS Version 21.0.
Segmentectomy was performed in 3,888 patients during the study period with 406 robotic, 1,837 VATS, and 1,645 open patients. VATS and robotic segmentectomy were performed more often at academic or comprehensive community cancer programs as compared to community programs ( < 0.05). Conversion to open thoracotomy was similar between robotic and VATS groups when stratified by hospital volume. Lymph node yield was significantly higher for robotic (median = 6), compared to VATS (median = 5) or open (median = 4; < 0.001). Length of stay was decreased for robotic versus open ( < 0.01). No differences in 30-day readmissions ( = 0.12) were observed among the 3 modalities. Overall survival was similar among groups ( = 0.18).
Robotic segmentectomy provides similar clinical outcomes compared to other standardized approaches for clinical T ≤2 cm, N0 NSCLC. A higher lymph node yield in robotic segmentectomy was not associated with improved survival in this study population.
在过去十年中，T ≤2 cm、N0 期非小细胞肺癌（NSCLC）的患者采用肺段切除术的比例有所增加。本研究旨在比较机器人手术、电视辅助胸腔镜手术（VATS）和开胸肺段切除术的临床结果和总生存率。
从国家癌症数据库中检索了 2010 年至 2015 年间接受机器人、胸腔镜（VATS）和开胸手术行肺段切除术的临床 T ≤2 cm、N0 NSCLC 患者。采用单因素和 Cox 回归分析比较手术方法，并评估总生存率的预测因素。统计分析采用 SPSS 版本 21.0。
在研究期间，有 3888 例患者接受了肺段切除术，其中 406 例采用机器人手术，1837 例采用 VATS，1645 例采用开胸手术。与社区项目相比，VATS 和机器人肺段切除术更多地在学术或综合社区癌症项目中进行（ < 0.05）。当按医院容量分层时，机器人与 VATS 组之间转为开胸手术的比例相似。机器人组的淋巴结收获量明显高于 VATS 组（中位数=6）和开胸组（中位数=4； < 0.001）。与开胸组相比，机器人组的住院时间缩短（ < 0.01）。3 种方式的 30 天再入院率无差异（ = 0.12）。各组之间的总生存率相似（ = 0.18）。
与其他标准化方法相比，机器人肺段切除术在治疗临床 T ≤2 cm、N0 NSCLC 方面具有相似的临床结果。在本研究人群中，机器人肺段切除术淋巴结收获量增加与生存改善无关。
