机器人辅助与电视辅助胸腔镜手术治疗胸腺瘤：来自欧洲胸外科医师学会数据库。

Robotic-assisted versus video-assisted thoracoscopic surgery for thymic epithelial tumours, from the European Society of Thoracic Surgeons Database.

机构信息

Department of Thoracic Surgery, Guy's Hospital, London, UK.

Department of Thoracic Surgery, University Hospital Torino, Turin, Italy.

出版信息

Eur J Cardiothorac Surg. 2024 Oct 1;66(4). doi: 10.1093/ejcts/ezae346.

DOI:10.1093/ejcts/ezae346

PMID:39325852

Abstract

OBJECTIVES

Minimally invasive thymectomy is an accepted approach for early-stage thymic epithelial neoplasia, reducing pain and length of stay compared with open surgery. In this study, we compare robotic and video-assisted thymectomy to assess pathological resection status, overall and disease-free survival.

METHODS

Data were retrieved from the European Society of Thoracic Surgeons prospectively maintained thymic database. Eighty-two international centres were invited to participate in the ESTS registry. Thirty-seven centres agreed to take part. We included all patients who had undergone complete thymectomy for malignancy through a minimally invasive approach and excluded patients in whom complete data were not available.

RESULTS

Between October 2001 and May 2021, a total of 899 patients with thymic malignancy underwent minimal access surgical resection and were included in the study. A propensity matched analysis was conducted with interrogation of 732 patients. Median age was 55 years, and 408 (56%) patients were female. Propensity matched was performed with 1:1 matching for surgical approach (video assisted = 366, robot assisted = 366). Robot-assisted surgery conferred significantly lower odds of incomplete resection (R1; 0.203 95% CI 0.13-0.317; P < 0.001). However, there was no difference in terms of overall and disease-free survival between the 2 techniques.

CONCLUSIONS

In this analysis, after adjusting for thymoma stage, the odds of incomplete surgical resection were higher in patients undergoing video-assisted surgery than robotic. However, there was no difference in overall or disease-free survival. With data maturation and increased follow-up, this would need repeat analysis and perhaps may provide more credence to the concept of a prospective randomized study to compare outcomes in thymic epithelial neoplasia by surgical approach with a standardized pathological work-up.

摘要

目的

微创胸腺切除术是早期胸腺癌的一种可接受的方法，与开放性手术相比，可减轻疼痛并缩短住院时间。本研究比较了机器人和电视辅助胸腺切除术，以评估病理切除状态、总生存率和无病生存率。

方法

数据来自欧洲胸外科协会前瞻性维护的胸腺数据库。邀请了 82 个国际中心参加 ESTS 注册。37 个中心同意参与。我们纳入了所有通过微创途径接受恶性肿瘤完全胸腺切除术的患者，并排除了不完全数据的患者。

结果

2001 年 10 月至 2021 年 5 月，共有 899 例胸腺恶性肿瘤患者接受微创外科切除术，纳入本研究。对 732 例患者进行了倾向匹配分析。中位年龄为 55 岁，408 例（56%）患者为女性。采用 1:1 匹配进行手术方法（电视辅助手术 366 例，机器人辅助手术 366 例）。机器人辅助手术显著降低了不完全切除的几率（R1；0.203 95%CI 0.13-0.317；P<0.001）。然而，两种技术在总生存率和无病生存率方面没有差异。