Shahoud James, Weksler Benny, Williams Brent, Maxwell Conor, Fernando Hiran C
Department of Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
Department of Thoracic and Cardiovascular Surgery, Division of Thoracic and Esophageal Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
J Thorac Dis. 2024 Nov 30;16(11):7539-7545. doi: 10.21037/jtd-24-919. Epub 2024 Nov 6.
There has been increasing adoption of robot-assisted thoracic surgery (RATS) and uniportal video-assisted thoracic surgery (uVATS) for lung resection. We undertook a single-institution retrospective study, comparing these approaches.
An analysis was performed of patients who underwent lung resection by either uVATS or RATS. Operations were performed between July 1, 2020 and July 1, 2021. Two surgeons [one experienced in RATS, the other experienced in multi-portal VATS (mVATS), with the recent adoption of uVATS] performed all operations. Patients with known or suspected lung cancer or metastases were included. In addition to baseline characteristics, adverse events [as defined in the Society of Thoracic Surgeons (STS) General Thoracic Database], subjective pain scores (scale 1-10), and morphine equivalent dose (MED) requirement were compared for patients who remained in the hospital on post-operative days (POD) 1 to 4. For patients with lung cancer, recurrence rates, overall survival, and recurrence-free survival were evaluated.
There were 128 (50 uVATS and 78 RATS) patients. Although uVATS patients were older (70 versus 65 years; P=0.01), there was no difference in baseline forced expiratory volume in the first second (FEV)%, diffusing capacity for carbon monoxide (DLCO)%, body mass index, and American Society of Anesthesiologists (ASA) scores. Mean procedure times and adverse event rates were similar. Four major complications occurred (all unanticipated return to the operating room). The 30- and 90-day mortality was zero. RATS was associated with shorter hospital stay (2.6 versus 4 days; P=0.02) and improved lymph node (15.3 versus 9.9; P=0.003) dissection. MED requirement was significantly reduced on POD 2-4 after uVATS, on both univariate and multivariate analysis. Ninety-four patients (uVATS; n=38, RATS; n=56) had primary lung cancer. Median follow-up was 15.6 months for these patients. Recurrence occurred in 4/34 (11.8%) uVATS and 7/56 (12.5%) RATS patients (P=0.77). There were no differences in overall survival or time to recurrence.
UVATS and RATS lung resections were associated with similar post-operative adverse event rates. Lymph node dissection and length of stay were improved with RATS. Oncological outcomes were similar. UVATS was associated with lower morphine requirement. Prospective studies will help further clarify the differences between these approaches.
机器人辅助胸外科手术（RATS）和单孔电视辅助胸外科手术（uVATS）在肺切除术中的应用越来越广泛。我们进行了一项单机构回顾性研究，比较这两种手术方式。
对接受uVATS或RATS肺切除术的患者进行分析。手术于2020年7月1日至2021年7月1日期间进行。两名外科医生[一名擅长RATS，另一名擅长多端口VATS（mVATS），最近开始采用uVATS]完成了所有手术。纳入已知或疑似肺癌或转移瘤的患者。除了基线特征外，还比较了术后第1至4天仍住院的患者的不良事件[如胸外科医师协会（STS）普通胸外科数据库所定义]、主观疼痛评分（1-10分）和吗啡等效剂量（MED）需求。对于肺癌患者，评估复发率、总生存率和无复发生存率。
共有128例患者（50例uVATS和78例RATS）。虽然uVATS组患者年龄较大（70岁对65岁；P = 0.01），但在基线第一秒用力呼气量（FEV）%、一氧化碳弥散量（DLCO）%、体重指数和美国麻醉医师协会（ASA）评分方面没有差异。平均手术时间和不良事件发生率相似。发生了4例主要并发症（均为意外返回手术室）。30天和90天死亡率为零。RATS与住院时间缩短（2.6天对4天；P = 0.02）和淋巴结清扫改善（15.3对9.9；P = 0.003）相关。在单因素和多因素分析中，uVATS术后第2至4天的MED需求均显著降低。94例患者（uVATS；n = 38，RATS；n = 56）患有原发性肺癌。这些患者的中位随访时间为15.6个月。4/34（11.8%）例uVATS患者和7/56（12.5%）例RATS患者出现复发（P = 0.77）。总生存率或复发时间没有差异。
uVATS和RATS肺切除术的术后不良事件发生率相似。RATS可改善淋巴结清扫和缩短住院时间。肿瘤学结果相似。uVATS与较低的吗啡需求量相关。前瞻性研究将有助于进一步阐明这些手术方式之间的差异。
