Zheng Qian, Ma Yong-Fu, Jiang Sha-Sha, Yu-Wen Si, Xu Yan, Liu Yang
Postgraduate School, Medical School of Chinese PLA, Beijing, China.
Department of Thoracic Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
J Thorac Dis. 2024 Oct 31;16(10):6368-6380. doi: 10.21037/jtd-24-946. Epub 2024 Oct 30.
Robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) are new modes for the surgical treatment of mediastinal tumors. The differences in perioperative efficacy and safety among RATS, VATS, and conventional open surgery (COS) are a major concern for surgeons. Most of the previous studies have not paid sufficient attention to mediastinal roof tumors. This study comprehensively analyzed the efficacy and safety of RATS, VATS, and COS for the surgical treatment of mediastinal roof tumors.
Patients who underwent resection of mediastinal roof tumors at our center from 2013 to 2023 were selected as the study cohort. Their perioperative and postoperative indexes were collected and cases were stratified according to tumor location for stratified analysis. The efficacy and safety of the three surgical methods were compared.
A total of 213 patients were enrolled in this study: 57 RATS (26.8%), 115 VATS (54.0%), and 41 COS (19.2%). RATS and VATS were shown to be superior to COS in intraoperative bleeding, thoracic drainage time, and postoperative hospital stay. RATS and VATS had similar advantages over COS in the treatment of anterior region tumors. RATS could shorten the postoperative hospital stay and reduce the incidence of postoperative composite adverse outcomes for posterior region tumors. When the maximum tumor diameter was ≥30 mm, the RATS group had obvious advantages.
Our study suggests that RATS and VATS are safe and feasible for the resection of mediastinal roof tumors. VATS may be more appropriate for anterior region tumors, and RATS has advantages for posterior region tumors and large tumors.
机器人辅助胸腔镜手术（RATS）和电视辅助胸腔镜手术（VATS）是纵隔肿瘤外科治疗的新模式。RATS、VATS与传统开放手术（COS）围手术期疗效和安全性的差异是外科医生主要关注的问题。以往大多数研究对纵隔顶部肿瘤关注不足。本研究综合分析了RATS、VATS和COS治疗纵隔顶部肿瘤的疗效和安全性。
选取2013年至2023年在本中心接受纵隔顶部肿瘤切除术的患者作为研究队列。收集其围手术期和术后指标，并根据肿瘤位置进行分层以作分层分析。比较三种手术方法的疗效和安全性。
本研究共纳入213例患者：57例行RATS手术（26.8%），115例行VATS手术（54.0%），41例行COS手术（19.2%）。结果显示，RATS和VATS在术中出血、胸腔引流时间和术后住院时间方面优于COS。在治疗前区肿瘤方面，RATS和VATS比COS具有相似的优势。RATS可缩短后区肿瘤患者的术后住院时间并降低术后复合不良结局的发生率。当肿瘤最大直径≥30 mm时，RATS组具有明显优势。
我们的研究表明，RATS和VATS用于纵隔顶部肿瘤切除是安全可行的。VATS可能更适合前区肿瘤，而RATS对后区肿瘤和大肿瘤具有优势。
