Lampridis Savvas, Maraschi Alessandro, Le Reun Corinne, Routledge Tom, Billè Andrea
Department of Thoracic Surgery, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK.
Independent Biostatistician, 97180 Sainte-Anne, Guadeloupe, France.
Cancers (Basel). 2023 Apr 21;15(8):2391. doi: 10.3390/cancers15082391.
Robot-assisted thoracic surgery (RATS) has gained popularity for the treatment of lung cancer, but its quality outcome measures are still being evaluated. The purpose of this study was to compare the perioperative outcomes of lung cancer resection using RATS versus video-assisted thoracic surgery (VATS). To achieve this aim, we conducted a retrospective analysis of consecutive patients who underwent lung cancer surgery between July 2015 and December 2020. A propensity-matched analysis was performed based on patients' performance status, forced expiratory volume in 1 s% of predicted, diffusing capacity of the lungs for carbon monoxide% of predicted, and surgical procedure (lobectomy or segmentectomy). Following propensity matching, a total of 613 patients were included in the analysis, of which 328 underwent RATS, and 285 underwent VATS, with satisfactory performance indicators. The results of the analysis indicated that RATS had a significantly longer operating time than VATS (132.4 ± 37.3 versus 122.4 ± 27.7 min; mean difference of 10 min 95% CI [confidence interval], 4.2 to 15.9 min; = 0.001). On the other hand, VATS had a significantly higher estimated blood loss compared to RATS (169.7 ± 237.2 versus 82.2 ± 195.4 mL; mean difference of 87.5 mL; 95% CI, 48.1 to 126.8 mL; < 0.001). However, there were no significant differences between the groups in terms of the duration of chest tubes, length of hospital stay, low- and high-grade complications, as well as readmissions and mortality within 30 days after surgery. Moreover, the number of dissected lymph-node stations was significantly higher with VATS than RATS (5.9 ± 1.5 versus 4.8 ± 2.2; mean difference of 1.2; 95% CI, 0.8 to 1.5; = 0.001). Nonetheless, the percentage of patients who were upstaged after histopathological analysis of the resected lymph nodes was similar between the two groups. In conclusion, RATS and VATS yielded comparable results for most of the short-term outcomes assessed. Further research is needed to validate the implementation of RATS and identify its potential benefits over VATS.
机器人辅助胸外科手术(RATS)在肺癌治疗中越来越受欢迎,但其质量结果指标仍在评估中。本研究的目的是比较使用RATS与电视辅助胸外科手术(VATS)进行肺癌切除的围手术期结果。为实现这一目标,我们对2015年7月至2020年12月期间连续接受肺癌手术的患者进行了回顾性分析。基于患者的体能状态、预测的第1秒用力呼气量百分比、预测的肺一氧化碳弥散量百分比以及手术方式(肺叶切除术或肺段切除术)进行倾向匹配分析。倾向匹配后,共有613例患者纳入分析,其中328例行RATS手术,285例行VATS手术,性能指标良好。分析结果表明,RATS的手术时间明显长于VATS(132.4±37.3对122.4±27.7分钟;平均差异10分钟,95%置信区间[CI],4.2至15.9分钟;P = 0.001)。另一方面,与RATS相比,VATS的估计失血量明显更高(169.7±237.2对82.2±195.4毫升;平均差异87.5毫升;95%CI,48.1至126.8毫升;P < 0.001)。然而,两组之间在胸管留置时间、住院时间、低级别和高级别并发症以及术后30天内的再入院率和死亡率方面没有显著差异。此外,VATS切除的淋巴结站数明显多于RATS(5.9±1.5对4.8±2.2;平均差异1.2;95%CI,0.8至1.5;P = 0.001)。尽管如此,两组之间经切除淋巴结的组织病理学分析后分期上调的患者百分比相似。总之,对于评估的大多数短期结果,RATS和VATS产生了可比的结果。需要进一步研究以验证RATS的实施并确定其相对于VATS的潜在益处。