Department of Thoracic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 069-8543, Japan.
Surg Today. 2023 Apr;53(4):428-434. doi: 10.1007/s00595-022-02578-5. Epub 2022 Sep 9.
The accuracy of lymph node (LN) dissection in robotic surgery for lung cancer remains controversial. We compared the accuracy of LN dissection in robot-assisted thoracic surgery (RATS) vs. video-assisted thoracic surgery (VATS).
The subjects of this retrospective analysis were 226 patients with cN0 primary lung cancer who underwent robot-assisted or video-assisted thoracic lobectomy with LN dissection, in our department, between April, 2016 and February, 2021. We compared the numbers of all LNs and mediastinal LNs dissected, the time required for LN dissection, complications, and upstaging rates of the N factor between the groups. Furthermore, we performed an inverse probability of treatment weighting-adjusted analysis to reduce potential bias between the groups.
The number of dissected LNs was higher in the RATS group in both the unweighted and weighted analyses. The time required for lymph node dissection was also longer in RATS. There was no significant difference in complications or in the upstaging rate of the N factor between the groups.
More LNs were dissected with RATS. Thus, the usefulness of robot-assisted surgery for LN dissection needs to be investigated further.
机器人手术中淋巴结（LN）清扫的准确性仍存在争议。我们比较了机器人辅助胸腔手术（RATS）与电视辅助胸腔手术（VATS）在 LN 清扫方面的准确性。
本回顾性分析的对象为 2016 年 4 月至 2021 年 2 月期间在我科行机器人辅助或电视辅助胸腔 lobectomy 伴 LN 清扫的 226 例 cN0 原发性肺癌患者。我们比较了两组患者清扫的所有淋巴结和纵隔淋巴结数量、LN 清扫所需时间、并发症和 N 因素的分期升级率。此外，我们进行了逆概率处理加权调整分析，以减少组间的潜在偏倚。
未加权和加权分析中，RATS 组清扫的淋巴结数量均较高。RATS 组淋巴结清扫时间也较长。两组间并发症或 N 因素分期升级率无显著差异。
RATS 组清扫的淋巴结更多。因此，机器人辅助手术在 LN 清扫中的应用价值需要进一步研究。
