不同体重指数范围的非小细胞肺癌患者行机器人辅助胸外科手术与电视辅助胸外科手术围手术期结局的比较
Comparison of the perioperative outcomes between robotic-assisted thoracic surgery and video-assisted thoracic surgery in non-small cell lung cancer patients with different body mass index ranges.
作者信息
Qu Chenghao, Li Rongyang, Ma Zheng, Han Jingyi, Yue Weiming, Aigner Clemens, Casiraghi Monica, Tian Hui
机构信息
Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China.
Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany.
出版信息
Transl Lung Cancer Res. 2022 Jun;11(6):1108-1118. doi: 10.21037/tlcr-22-137.
BACKGROUND
Non-small cell lung cancer (NSCLC) is the most common malignancy and one of the most common causes of cancer-related death worldwide. Robotic-assisted thoracic surgery (RATS) has gradually become a prevalent surgical method for patients with NSCLC. Previous studies have found that body mass index (BMI) is associated with postoperative outcomes. This study aimed to investigate the effectiveness of RATS compared to video-assisted thoracic surgery (VATS) in the treatment of NSCLC with different BMI, in terms of perioperative outcomes.
METHODS
The baseline and perioperative data, including BMI, of 849 NSCLC patients who underwent minimally invasive anatomic lung resections from August 2020 to April 2021 were retrospectively collected and analyzed. Propensity score matching analysis was applied to minimize potential bias between the two groups (VATS and RATS), and the perioperative outcomes were compared. Subgroup analysis was subsequently performed.
RESULTS
Compared to VATS, RATS had more lymph nodes dissected {9 [inter-quartile range (IQR), 6-12] 7 (IQR, 6-10), P<0.001}, a lower estimated bleeding volume [40 (IQR, 30-50) 50 (IQR, 40-60) mL, P<0.001], and other better postoperative outcomes, but a higher cost of hospitalization [¥83,626 (IQR, 77,211-92,686) ¥75,804 (IQR, 66,184-83,693), P<0.001]. Multivariable logistic regression analysis indicated that RATS (P=0.027) and increasing BMI (P=0.030) were associated with a statistically significant reduction in the risk of postoperative complications. Subgroup analysis indicated that the advantages of RATS may be more obvious in patients with a BMI of 24-28 kg/m, in which the RATS group had more lymph nodes dissected [9 (IQR, 6-12) 7 (IQR, 5-10), P<0.001] and a decreased risk of total postoperative complications [odds ratio (OR), 0.443; 95% confidence interval (CI), 0.212-0.924; P=0.030] compared to the VATS group.
CONCLUSIONS
Both, RATS and VATS can be safely applied for patients with NSCLC. Perioperative outcome parameters indicate advantages for RATS, however at a higher cost of hospitalization. The advantages of RATS might be more obvious in patients with a BMI of 24-28 kg/m.
背景
非小细胞肺癌（NSCLC）是全球最常见的恶性肿瘤，也是癌症相关死亡的最常见原因之一。机器人辅助胸外科手术（RATS）已逐渐成为NSCLC患者的一种普遍手术方法。既往研究发现，体重指数（BMI）与术后结局相关。本研究旨在探讨在围手术期结局方面，RATS与电视辅助胸腔镜手术（VATS）相比，治疗不同BMI的NSCLC的有效性。
方法
回顾性收集并分析了2020年8月至2021年4月期间接受微创解剖性肺切除术的849例NSCLC患者的基线和围手术期数据，包括BMI。采用倾向评分匹配分析以最小化两组（VATS和RATS）之间的潜在偏倚，并比较围手术期结局。随后进行亚组分析。
结果
与VATS相比，RATS切除的淋巴结更多{9个[四分位数间距（IQR），6 - 12个]对7个（IQR，6 - 10个），P<0.001}，估计出血量更低[40（IQR，30 - 50）对50（IQR，40 - 60）mL，P<0.001]，且术后其他结局更好，但住院费用更高[83,626元（IQR，77,211 - 92,686元）对75,804元（IQR，66,184 - 83,693元），P<0.001]。多变量逻辑回归分析表明，RATS（P = 0.027）和BMI增加（P = 0.030）与术后并发症风险的统计学显著降低相关。亚组分析表明，RATS的优势在BMI为24 - 28 kg/m的患者中可能更明显，其中RATS组切除的淋巴结更多[9个（IQR，6 - 12个）对7个（IQR，5 - 10个），P<0.001]，与VATS组相比，术后总并发症风险降低[比值比（OR），0.443；95%置信区间（CI），0.212 - 0.924；P = 0.030]。
结论
RATS和VATS均可安全应用于NSCLC患者。围手术期结局参数表明RATS具有优势，但住院费用更高。RATS的优势在BMI为24 - 28 kg/m的患者中可能更明显。
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