Adamica Dávid, Tulinský Lubomír, Kepičová Markéta, Dzurňáková Paula, Ihnát Peter, Mitták Marcel, Varga Adam, Neoral Čestmír, Martínek Lubomír
Department of Surgery, University Hospital Ostrava, 17. Listopadu 1790, Ostrava, 708 52, Czech Republic.
Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic.
J Robot Surg. 2025 Jun 4;19(1):263. doi: 10.1007/s11701-025-02392-4.
The objective of this study is to undertake a narrative review of the oncological adequacy of mediastinal lymphadenectomy performed via robot-assisted thoracic surgery (RATS) in comparison with video-assisted thoracic surgery (VATS) and thoracotomy for non-small cell lung cancer (NSCLC). The focus of the review is on lymph node yield, nodal station dissection, and nodal upstaging rates. A narrative review of literature published in the last decade was conducted using PubMed, Cochrane, and Web of Science databases. Studies examining mediastinal lymphadenectomy outcomes for RATS, VATS, or thoracotomy were included in the discussion. The analysis of 19 studies from diverse geographical regions showed that in six out of nine comparative studies, RATS demonstrated superior lymph node retrieval compared to VATS, with statistically significant differences. RATS achieved comparable or superior nodal station dissection rates and showed particular advantages in upstaging from clinical N0 to pathological N2 status. Additionally, RATS demonstrated favourable perioperative outcomes with reduced morbidity and mortality rates compared to conventional approaches. RATS represents a reliable and oncologically sound approach to mediastinal lymphadenectomy, with potential advantages over conventional techniques. Its enhanced visualization and precision make it an increasingly utilised option for NSCLC treatment in centres with robotic capabilities.
本研究的目的是对机器人辅助胸腔镜手术（RATS）与电视辅助胸腔镜手术（VATS）及开胸手术相比，用于非小细胞肺癌（NSCLC）纵隔淋巴结清扫的肿瘤学充分性进行叙述性综述。综述的重点是淋巴结获取量、淋巴结站清扫情况以及淋巴结分期上调率。使用PubMed、Cochrane和科学网数据库对过去十年发表的文献进行了叙述性综述。讨论中纳入了研究RATS、VATS或开胸手术纵隔淋巴结清扫结果的研究。对来自不同地理区域的19项研究的分析表明，在9项比较研究中的6项中，与VATS相比，RATS显示出更好的淋巴结获取情况，差异具有统计学意义。RATS实现了相当或更好的淋巴结站清扫率，并且在从临床N0分期上调至病理N2分期方面显示出特别的优势。此外，与传统方法相比，RATS显示出良好的围手术期结果，发病率和死亡率降低。RATS是一种可靠且在肿瘤学上合理的纵隔淋巴结清扫方法，相对于传统技术具有潜在优势。其增强的可视化和精确性使其在具备机器人手术能力的中心越来越多地被用于NSCLC治疗。
