Department of Thoracic Surgery, IEO-European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Italy.
Department of Thoracic Surgery, IEO-European Institute of Oncology IRCCS, Milan, Italy.
Lung Cancer. 2024 Sep;195:107903. doi: 10.1016/j.lungcan.2024.107903. Epub 2024 Jul 31.
This study aimed at describing our high-volume single center experience in robotic-assisted thoracic surgery (RATS) to evaluate short outcome and feasibility of the technique, the adequacy of oncological results, and the learning curve.
We retrospectively analyzed data from 1000 consecutive patients who underwent lobectomy and systematic lymphadenectomy for primary lung cancer using RATS approach between May 2007 and May 2023.
Nine-hundred ninety-seven patients (99.7 %) underwent lobectomy, whereas 3 (0.03 %) patients bilobectomy. Conversion rate to open surgery was 3.7 %. Minor complications occurred in 213 (21.3 %) patients, major complications in 29 patients (2.9 %). The 30-day and 90-day operative mortality was 0 % and 0.1 %, respectively. The median number of N1 + N2 stations resected was 5 (range 0-9), with a median number of 17 of N1 + N2 lymph nodes resected (range 0-55). The oncological outcome was evaluated only on the subgroup of patients (n = 895) with non-small cell lung cancer. Pathological lymph node upstaging from cN0 to pN1/pN2 was evident in 147 patients (17.3 %): 9 % from cN0 to pN1 and 7.1 % from cN0 to pN2. With a median follow-up of 3.9, 5-year OS and DFS were respectively 89.3 % and 83.6 % for stage I, 74 % and 66.5 % for stage II, and 61 % and 36.4 % for stage IIIA.
Better vision and excellent instrument maneuverability of the robotic surgical system allowed excellent results in terms of early, adequate oncological outcome comparable to open surgery literature data, and acceptable learning curve.
1000 consecutive patients who underwent lobectomy and systematic lymphadenectomy for primary lung cancer using RATS approach have been analyzed with the aim to describe our high-volume single center experience, and to evaluate short outcome and feasibility of the technique, the adequacy of oncological results, and the learning curve.
本研究旨在描述我们在机器人辅助胸外科（RATS）方面的大容量单中心经验，以评估该技术的短期结果和可行性、肿瘤学结果的充分性以及学习曲线。
我们回顾性分析了 2007 年 5 月至 2023 年 5 月期间 1000 例连续接受 RATS 方法行肺叶切除术和系统淋巴结清扫术治疗原发性肺癌的患者数据。
997 例（99.7%）患者行肺叶切除术，3 例（0.03%）患者行双肺叶切除术。中转开胸手术的比例为 3.7%。213 例（21.3%）患者发生轻微并发症，29 例（2.9%）患者发生严重并发症。30 天和 90 天手术死亡率分别为 0%和 0.1%。切除的 N1+N2 淋巴结站中位数为 5 个（范围 0-9），切除的 N1+N2 淋巴结中位数为 17 个（范围 0-55）。仅对非小细胞肺癌患者（n=895）亚组评估了肿瘤学结果。从 cN0 到 pN1/pN2 的病理淋巴结分期升高在 147 例患者中明显（17.3%）：9%从 cN0 到 pN1，7.1%从 cN0 到 pN2。中位随访 3.9 年后，I 期、II 期和 IIIA 期的 5 年 OS 和 DFS 分别为 89.3%和 83.6%、74%和 66.5%、61%和 36.4%。
机器人手术系统的良好视野和出色的器械操作能力，使早期肿瘤学结果达到了出色的水平，与开放手术文献数据相当，且学习曲线可接受。
