新辅助化疗免疫治疗后非小细胞肺癌患者行机器人辅助胸外科手术的安全性与可行性
Safety and feasibility of robotic-assisted thoracic surgery after neoadjuvant chemoimmunotherapy in non-small cell lung cancer.
作者信息
Zeng Jun, Yi Bin, Chang Ruimin, Chen Yufan, Yu Zhongjie, Gao Yang
机构信息
Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Hunan Engineering Research Center for Pulmonary Nodules Precise Diagnosis and Treatment, Xiangya Hospital, Central South University, Changsha, Hunan, China.
出版信息
Front Oncol. 2023 Feb 23;13:1134713. doi: 10.3389/fonc.2023.1134713. eCollection 2023.
OBJECTIVES
This study aimed to evaluate the safety and feasibility of robotic-assisted thoracic surgery (RATS) after neoadjuvant chemoimmunotherapy in NSCLC.
METHODS
We retrospectively collected data for NSCLC patients who received thoracic surgery after neoadjuvant chemoimmunotherapy from May 2020 to August 2022. Surgery details, pathological response, and perioperative outcome were compared between video-assisted thoracic surgery (VATS) group and RATS group. Inverse probability of treatment weighting (IPTW) was used to equal the baseline characteristics.
RESULTS
A total of 220 patients were divided into 78 VATS patients and 142 RATS patients. There was no 90-day mortality in either group. RATS patients demonstrated better results in conversion rate to thoracotomy (VATS vs. RATS: 28.2% vs. 7.5%, < 0.001), number of lymph node stations harvested (5.63 ± 1.75 vs. 8.09 ± 5.73, < 0.001), number of lymph nodes harvested (13.49 ± 9.325 vs. 20.35 ± 10.322, < 0.001), yield pathologic-N (yp-N) assessment (yp-N0, 88.5% vs. 67.6%; yp-N1, 7.6% vs. 12.6%; yp-N2, 3.8% vs. 19.7%; < 0.001), and visual analog scale pain score after surgery (4.41 ± 0.93 vs. 3.77 ± 1.21, =0.002). However, there were no significant differences in pathological response evaluation for neoadjuvant chemoimmunotherapy ( = 0.493) and complication rate ( = 0.803). After IPTW-adjustment, these results remained constant.
CONCLUSIONS
RATS reduced the risk of conversion to thoracotomy, provided a better yp-N stage evaluation, and improved pain score; this suggests that RATS is safe and feasible for NSCLC patients after neoadjuvant chemoimmunotherapy.
目的
本研究旨在评估新辅助化疗免疫治疗后非小细胞肺癌（NSCLC）患者行机器人辅助胸腔镜手术（RATS）的安全性和可行性。
方法
我们回顾性收集了2020年5月至2022年8月期间接受新辅助化疗免疫治疗后行胸外科手术的NSCLC患者的数据。比较了电视辅助胸腔镜手术（VATS）组和RATS组的手术细节、病理反应和围手术期结果。采用治疗权重逆概率（IPTW）来平衡基线特征。
结果
共220例患者分为78例VATS患者和142例RATS患者。两组均无90天死亡率。RATS组患者在开胸转换率（VATS组 vs. RATS组：28.2% vs. 7.5%，<0.001）、清扫淋巴结站数（5.63±1.75 vs. 8.09±5.73，<0.001）、清扫淋巴结数（13.49±9.325 vs. 20.35±10.322，<0.001）、yp-N分期评估（yp-N0，88.5% vs. 67.6%；yp-N1，7.6% vs. 12.6%；yp-N2，3.8% vs. 19.7%；<0.001）以及术后视觉模拟评分法疼痛评分（4.41±0.93 vs. 3.77±1.21，=0.002）方面表现更好。然而，新辅助化疗免疫治疗的病理反应评估（=0.493）和并发症发生率（=0.803）无显著差异。经IPTW调整后，这些结果保持不变。
结论
RATS降低了开胸转换风险，提供了更好的yp-N分期评估，并改善了疼痛评分；这表明RATS对新辅助化疗免疫治疗后的NSCLC患者是安全可行的。
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