Zirafa Carmelina Cristina, Romano Gaetano, Sicolo Elisa, Cariello Claudia, Morganti Riccardo, Conoscenti Lucia, Hung-Key Teresa, Davini Federico, Melfi Franca
Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy.
Cardiothoracic and Vascular Anaesthesia and Intensive Care, Department of Anaesthesia and Critical Care Medicine, University Hospital of Pisa, 56124 Pisa, Italy.
J Clin Med. 2021 Sep 26;10(19):4408. doi: 10.3390/jcm10194408.
Robotic-assisted pulmonary resection has greatly increased over the last few years, yet data on the application of robotic surgery in high-risk patients are still lacking. The objective of this study is to evaluate the perioperative outcomes in ASA III-IV patients who underwent robotic-assisted lung resection for NSCLC. Between January 2010 and December 2017, we retrospectively collected the data of 148 high-risk patients who underwent lung resection for NSCLC via a robotic approach at our institution. For this study, the prediction of operative risk was based on the ASA-PS score, considering patients in ASA III and IV classes as high-risk patients: of the 148 high-risk patients identified, 146 patients were classified as ASA III (44.8%) and two as ASA IV (0.2%). Possible prognostic factors were also analysed. The average hospital stay was 6 days (8-30). Post-operative complications were observed in 87 (58.8%) patients. Patients with moderate/severe COPD developed in 33 (80.5%) cases post-operative complications, while elderly patients in 25 (55%) cases, with a greater incidence of high-grade complications. No difference was observed when comparing the data of obese and non-obese patients. Robotic surgery appears to be associated with satisfying post-operative results in ASA III-IV patients. Both marginal respiratory function and advanced age represent negative prognostic factors. Due to its safety and efficacy, robotic surgery can be considered the treatment of choice in high-risk patients.
在过去几年中，机器人辅助肺切除术的应用大幅增加，但关于机器人手术在高危患者中的应用数据仍然匮乏。本研究的目的是评估接受机器人辅助肺癌切除术的美国麻醉医师协会（ASA）III-IV级患者的围手术期结局。在2010年1月至2017年12月期间，我们回顾性收集了在我院通过机器人手术方法接受非小细胞肺癌肺切除术的148例高危患者的数据。在本研究中，手术风险的预测基于ASA-PS评分，将ASA III级和IV级患者视为高危患者：在确定的148例高危患者中，146例患者被分类为ASA III级（44.8%），2例为ASA IV级（0.2%）。还分析了可能的预后因素。平均住院时间为6天（8-30天）。87例（58.8%）患者出现术后并发症。中度/重度慢性阻塞性肺疾病（COPD）患者术后并发症发生率为33例（80.5%），老年患者为25例（55%），高级别并发症发生率更高。比较肥胖和非肥胖患者的数据时未观察到差异。机器人手术似乎与ASA III-IV级患者令人满意的术后结果相关。边缘呼吸功能和高龄均为负面预后因素。由于其安全性和有效性，机器人手术可被视为高危患者的首选治疗方法。
