Habibi Nameghi Fatemeh, Oghogho Asemota, Baltag Diana, Szafron Bartlomiej, Viola Cristina, Kadlec Jakub, Bartosik Waldemar, Irvine Michael, Kouritas Vasileios
Department of Thoracic Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
Norwich Medical School, University of East Anglia, Norwich, UK.
J Robot Surg. 2025 May 22;19(1):225. doi: 10.1007/s11701-025-02344-y.
Robotic-assisted thoracoscopic surgery (RATS) is offered to early-stage, low-risk patients. This study compares the outcomes of high-risk malignancy patients who received RATS lung resection with propensity matched similar patients operated via video-assisted thoracoscopic surgery (VATS) and open thoracotomy (OT). All patients discussed at our high-risk meeting who had resections via RATS, VATS or OT between May 2019 and August 2023 were retrospectively investigated. Propensity-matched RATS, VATS and OT groups were created. 145 patients were analysed. The mean age was 71.3 ± 8.4 years and 63 (43.5%) were females. After propensity matching, three groups were created including 31 RATS, 31 VATS, and 31 OT patients. The three groups were similar in baseline characteristics. More segmentectomies were performed via RATS than via VATS or OT (29% vs 9.7% vs 9.7%, respectively, p = 0.009). Length of stay (LOS) and critical care complex CCC-LOS were shorter in the RATS group when compared to VATS or OT (p < 0.001 and p < 0.0001, respectively). Overall and respiratory complications were lower in RATS compared to VATS or OT (35.5% vs 48.4% vs 71%, p = 0.039 and 12.9% vs 38.7% vs 35.5%, p = 0.035, respectively). Unplanned admissions to CCC were lower in the RATS versus the VATS and OT groups (3.2% vs 12.9% vs 22.6%, respectively, p = 0.014). All other variables investigated were similar between groups. Offering RATS lung resections to high-risk patients is a viable surgical option for lung malignancy. The historical consensus to exclude RATS in such patients should be reevaluated as it may confer superior clinical outcomes to other approaches.
机器人辅助胸腔镜手术（RATS）适用于早期、低风险患者。本研究比较了接受RATS肺切除术的高危恶性肿瘤患者与倾向匹配的通过电视辅助胸腔镜手术（VATS）和开胸手术（OT）进行手术的类似患者的结局。对2019年5月至2023年8月期间在我们的高危会议上讨论过且通过RATS、VATS或OT进行切除术的所有患者进行了回顾性研究。创建了倾向匹配的RATS、VATS和OT组。对145例患者进行了分析。平均年龄为71.3±8.4岁，女性63例（43.5%）。倾向匹配后，创建了三组，包括31例RATS患者、31例VATS患者和31例OT患者。三组的基线特征相似。通过RATS进行的肺段切除术比通过VATS或OT更多（分别为29%对9.7%对9.7%，p = 0.009）。与VATS或OT相比，RATS组的住院时间（LOS）和重症监护综合住院时间（CCC-LOS）更短（分别为p < 0.001和p < 0.0001）。与VATS或OT相比，RATS的总体并发症和呼吸系统并发症更低（分别为35.5%对48.4%对71%，p = 0.039；12.9%对38.7%对35.5%，p = 0.035）。RATS组的CCC非计划入院率低于VATS组和OT组（分别为3.2%对12.9%对22.6%，p = 0.014）。研究的所有其他变量在组间相似。为高危患者提供RATS肺切除术是治疗肺恶性肿瘤的一种可行手术选择。对于此类患者排除RATS的历史共识应重新评估，因为它可能比其他方法带来更好的临床结局。
