Casiraghi Monica, Mariolo Alessio Vincenzo, Mohamed Shehab, Sedda Giulia, Maisonneuve Patrick, Mazzella Antonio, Lo Iacono Giorgio, Petrella Francesco, Spaggiari Lorenzo
Department of Thoracic Surgery, IEO-European Institute of Oncology IRCCS, 20141 Milan, Italy.
Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy.
J Clin Med. 2022 Jun 11;11(12):3363. doi: 10.3390/jcm11123363.
This study makes a comparison between stage I non-small cell lung cancer (NSCLC) patients subjected to either robotic-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS) or open thoracotomy, with the aim to evaluate differences between these three approaches in terms of oncological outcomes.
We reviewed data from 1367 consecutive patients who, between 2011 and 2017, underwent lobectomy for NSCLC with either open surgery, VATS or RATS, and performed a matched case-control study based on patients' age, gender, clinical stage (IA, IB) and ASA score.
180 patients (n = 72 RATS, n = 36 VATS, n = 72 open) were analyzed. Complication rates were found to be comparable (72.2% open, 86.1% VATS, 81.9% RATS), with similar grades of severity. The median number of resected lymph nodes was higher in open surgery (n = 22) than in VATS (n = 15; = 0.0001) and in RATS (n = 17; = 0.004). Pathological N2 upstaging was higher in open surgery (9.7%) compared to VATS (5.6%) and RATS (5.6%). However, the recurrence rate in VATS was significantly higher than in RATS (log rank = 0.03). No statistically significant differences were detected in 5-year OS and cancer-specific survival.
no differences were found in OS and cancer-specific survival between VATS, RATS and open lobectomy for stage I NSCLC patients; even if in VATS, the incidence of recurrences, in particular local recurrences, was higher than in RATS and in open surgery.
本研究对接受机器人辅助胸外科手术（RATS）、电视辅助胸外科手术（VATS）或开胸手术的I期非小细胞肺癌（NSCLC）患者进行了比较，旨在评估这三种手术方式在肿瘤学结局方面的差异。
我们回顾了2011年至2017年间1367例连续接受NSCLC肺叶切除术的患者的数据，这些患者接受的手术方式为开放手术、VATS或RATS，并根据患者的年龄、性别、临床分期（IA、IB）和ASA评分进行了匹配病例对照研究。
分析了180例患者（RATS组72例，VATS组36例，开放手术组72例）。发现并发症发生率相当（开放手术组为72.2%，VATS组为86.1%，RATS组为81.9%），严重程度相似。开放手术切除的淋巴结中位数（n = 22）高于VATS（n = 15；P = 0.0001）和RATS（n = 17；P = 0.004）。开放手术的病理N2期上调率（9.7%）高于VATS（5.6%）和RATS（5.6%）。然而，VATS组的复发率显著高于RATS组（对数秩检验P = 0.03）。5年总生存期和癌症特异性生存期未检测到统计学显著差异。
对于I期NSCLC患者，VATS、RATS和开放肺叶切除术在总生存期和癌症特异性生存期方面未发现差异；即使在VATS组中，复发率，尤其是局部复发率高于RATS组和开放手术组。
