Novellis Pierluigi, Maisonneuve Patrick, Dieci Elisa, Voulaz Emanuele, Bottoni Edoardo, Di Stefano Sara, Solinas Michela, Testori Alberto, Cariboni Umberto, Alloisio Marco, Veronesi Giulia
Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy.
J Clin Med. 2021 Apr 14;10(8):1687. doi: 10.3390/jcm10081687.
We compare the perioperative course, postoperative pain, and quality-of-life (QOL) in patients undergoing anatomic resections of early-stage lung cancer by means of robotic surgery (RATS), video-assisted thoracic surgery (VATS), or muscle-sparing thoracotomy (OPEN); 169 consecutive patients with known/suspected lung cancer, candidates to anatomic resection, were enrolled in a single-center prospective study from April 2016 to December 2018. EORTC QLQ-C30 and QLQ-LC13 scores were obtained preoperatively and, at three time points, postoperatively. RATS and VATS groups were matched for ASA scores, while RATS and open surgery were matched for gender, ASA score, cancer stage, and tumor size; 58 patients underwent open surgery, 58 had VATS, and 53 had RATS. Hospital stay was shorter after RATS than OPEN (median 4.5 versus 5; = 0.047). Comparing matched RATS and VATS groups, the number of hilar lymph nodes and nodal stations removed was significantly higher in the former approach ( = 0.01 vs. < 0.0001); conversely, pain at 2 weeks was slightly lower after VATS ( = 0.004). No significant difference was observed in conversions, complications, duration of surgery, and postoperative hospitalization. The robotic approach was superior to OPEN in terms of QOL, pain, and length of postoperative stay and showed improved lymph node dissection compared to VATS.
我们比较了通过机器人手术（RATS）、电视辅助胸腔镜手术（VATS）或保留肌肉开胸手术（OPEN）进行早期肺癌解剖性切除的患者的围手术期过程、术后疼痛和生活质量（QOL）；2016年4月至2018年12月，169例已知/疑似肺癌且适合解剖性切除的连续患者被纳入一项单中心前瞻性研究。术前及术后三个时间点获取欧洲癌症研究与治疗组织（EORTC）QLQ-C30和QLQ-LC13评分。RATS组和VATS组根据美国麻醉医师协会（ASA）评分进行匹配，而RATS组和开放手术组根据性别、ASA评分、癌症分期和肿瘤大小进行匹配；58例患者接受开放手术，58例接受VATS，53例接受RATS。RATS术后住院时间比OPEN短（中位数4.5天对5天；P = 0.047）。比较匹配的RATS组和VATS组，前一种方法切除的肺门淋巴结数量和淋巴结站数显著更多（P = 0.01对P < 0.0001）；相反，VATS术后2周时疼痛略轻（P = 0.004）。在中转率、并发症、手术时间和术后住院时间方面未观察到显著差异。机器人手术方法在生活质量、疼痛和术后住院时间方面优于OPEN，并且与VATS相比，淋巴结清扫效果更佳。
