Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Division of Thoracic Surgery, Duke University, Durham, NC.
Ann Surg. 2023 Jun 1;277(6):1002-1009. doi: 10.1097/SLA.0000000000005820. Epub 2023 Feb 10.
The aim of this study was to analyze overall survival (OS) of robotic-assisted lobectomy (RL), video-assisted thoracoscopic lobectomy (VATS), and open lobectomy (OL) performed by experienced thoracic surgeons across multiple institutions.
Surgeons have increasingly adopted RL for resection of early-stage lung cancer. Comparative survival data following these approaches is largely from single-institution case series or administrative data sets.
Retrospective data was collected from 21 institutions from 2013 to 2019. Consecutive cases performed for clinical stage IA-IIIA lung cancer were included. Induction therapy patients were excluded. The propensity-score method of inverse-probability of treatment weighting was used to balance baseline characteristics. OS was estimated using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to evaluate association among OS and relevant risk factors.
A total of 2789 RL, 2661 VATS, and 1196 OL cases were included. The unadjusted 5-year OS rate was highest for OL (84%) followed by RL (81%) and VATS (74%); P =0.008. Similar trends were also observed after inverse-probability of treatment weighting adjustment (RL 81%; VATS 73%, OL 85%, P =0.001). Multivariable Cox regression analyses revealed that OL and RL were associated with significantly higher OS compared with VATS (OL vs. VATS: hazard ratio=0.64, P <0.001 and RL vs. VATS: hazard ratio=0.79; P =0.007).
Our finding from this large multicenter study suggests that patients undergoing RL and OL have statistically similar OS, while the VATS group was associated with shorter OS. Further studies with longer follow-up are necessary to help evaluate these observations.
本研究旨在分析经验丰富的胸外科医生在多个机构中进行的机器人辅助肺叶切除术（RL）、电视辅助胸腔镜肺叶切除术（VATS）和开胸肺叶切除术（OL）的总生存率（OS）。
外科医生越来越多地采用 RL 进行早期肺癌切除术。这些方法的比较生存数据主要来自单机构病例系列或行政数据集。
从 2013 年至 2019 年，从 21 个机构收集了回顾性数据。纳入了临床分期 I 期至 IIIA 期肺癌的连续病例。排除了诱导治疗患者。采用逆概率治疗加权的倾向评分法来平衡基线特征。使用 Kaplan-Meier 法估计 OS。多变量 Cox 比例风险模型用于评估 OS 与相关危险因素之间的关联。
共纳入 2789 例 RL、2661 例 VATS 和 1196 例 OL 病例。未调整的 5 年 OS 率 OL 最高（84%），其次是 RL（81%）和 VATS（74%）；P=0.008。在进行治疗可能性反概率加权调整后，也观察到了类似的趋势（RL 81%；VATS 73%，OL 85%，P=0.001）。多变量 Cox 回归分析显示，OL 和 RL 与 VATS 相比，OS 显著更高（OL 与 VATS：风险比=0.64，P<0.001，RL 与 VATS：风险比=0.79；P=0.007）。
我们从这项大型多中心研究中得出的发现表明，接受 RL 和 OL 的患者的 OS 统计上相似，而 VATS 组的 OS 较短。需要进一步进行更长随访的研究来帮助评估这些观察结果。
