Kato Taketo, Watanabe Hiroki, Kawasumi Yuta, Kadomatsu Yuka, Ueno Harushi, Nakamura Shota, Mizuno Tetsuya, Chen-Yoshikawa Toyofumi Fengshi
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
Gen Thorac Cardiovasc Surg. 2025 Jun;73(6):443-449. doi: 10.1007/s11748-024-02093-z. Epub 2024 Oct 28.
Following the introduction of robot-assisted thoracoscopic surgery (RATS) as a health insurance-covered treatment in Japan, we investigated the current status and impact of the expansion of the indications for RATS for mediastinal tumors.
Between 2018 and 2022, 209 cases of total mediastinal tumor resection were performed in our hospital. The study period was divided into the first half (January 2018 to June 2020) and the second half (July 2020 to December 2022), and perioperative parameters were compared between the two groups.
Ninety-six surgical procedures were performed in the first half and 113 in the second half. The percentage of RATS approach was significantly higher in the second half compared with the first half (P < 0.001). Indications for RATS in the second half compared with the first half were significantly increased in patients with stage II (P < 0.001) and stage III (P = 0.026) thymomas, tumor diameter ≥ 50 mm (P < 0.011), and patients undergoing extended thymectomy for myasthenia gravis (P < 0.009). In respect of short-term postoperative parameters, the estimated intraoperative blood loss (P < 0.035), postoperative drain duration (P < 0.037), and postoperative hospital stay (P < 0.011) were significantly lower in the second half than in the first half.
RATS has recently been expanded for mediastinal tumors with improved short-term outcomes in our hospital after health insurance was applied in Japan. In the future, it will be necessary to discuss the further expansion of its indications by taking into account safety and long-term outcomes.
在日本将机器人辅助胸腔镜手术（RATS）作为医疗保险覆盖的治疗方法引入后，我们调查了RATS治疗纵隔肿瘤适应症扩大的现状及影响。
2018年至2022年期间，我院共进行了209例全纵隔肿瘤切除术。研究期分为上半年（2018年1月至2020年6月）和下半年（2020年7月至2022年12月），比较两组的围手术期参数。
上半年进行了96例手术，下半年进行了113例。下半年RATS手术方式的比例显著高于上半年（P < 0.001）。与上半年相比，下半年II期（P < 0.001）和III期（P = 0.026）胸腺瘤、肿瘤直径≥50 mm（P < 0.011）以及因重症肌无力接受扩大胸腺切除术的患者（P < 0.009）中RATS的适应症显著增加。在术后短期参数方面，下半年的估计术中失血量（P < 0.035）、术后引流持续时间（P < 0.037）和术后住院时间（P < 0.011）均显著低于上半年。
在日本实施医疗保险后，我院近期扩大了RATS治疗纵隔肿瘤的应用范围，短期疗效有所改善。未来，有必要在考虑安全性和长期疗效的基础上讨论其适应症的进一步扩大。
