Casiraghi Monica, Orlandi Riccardo, Mazzella Antonio, Girelli Lara, Caffarena Giovanni, Chiari Matteo, Bertolaccini Luca, Lo Iacono Giorgio, Diotti Cristina, Bardoni Claudia, Maisonneuve Patrick, Spaggiari Lorenzo
Department of Thoracic Surgery, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy.
Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy.
J Clin Med. 2025 Aug 8;14(16):5608. doi: 10.3390/jcm14165608.
Robotic-assisted segmentectomy (RAS) has proven to be safe and feasible for early-stage lung cancer; nonetheless, its oncologic efficacy and long-term outcomes are still debated. We aimed to explore whether RAS could be an alternative to robotic-assisted lobectomy (RAL) in early-stage NSCLC, focusing on long-term outcomes such as 10-year cancer-specific survival (CSS), cumulative rate of relapse (RR), and local recurrence (LR). Patients undergoing RAS for early-stage NSCLC (clinical stage I) were analyzed from August 2007 to August 2023. A 1:3 propensity score-matched analysis was performed among patients undergoing RAL, based on demographic characteristics and pathological stage. Primary endpoints were CSS, RR, and LR. A total of 40 patients undergoing RAS were retrospectively enrolled. After matching 120 patients undergoing RAL, no significant differences were found in postoperative complications, median operative time, or length of hospital stay. Patients undergoing RAS had comparable 10-year CSS ( = 0.90) and RR ( = 0.99) to those undergoing RAL, whereas 10-year of cumulative incidence of local recurrence (LR) was 11.0% (95% CI: 3.4-23.7%) for RAS patients and 2.8% (95% CI: 0.5-8.9%) for RAL patients ( = 0.08). Additionally, RAL provided a significantly higher number of N1 and N2 lymph node retrievals ( < 0.0001 and 0.06, respectively), as well as a higher number of N2 stations ( = 0.0001). Based on our experiences, even though RAS can ensure excellent long-term outcomes in selected cases of early-stage NSCLC, comparable to RAL, the local recurrence rate was higher in the RAS group.
机器人辅助肺段切除术（RAS）已被证明对早期肺癌是安全可行的；尽管如此，其肿瘤学疗效和长期结果仍存在争议。我们旨在探讨RAS在早期非小细胞肺癌（NSCLC）中是否可作为机器人辅助肺叶切除术（RAL）的替代方案，重点关注10年癌症特异性生存率（CSS）、累积复发率（RR）和局部复发（LR）等长期结果。对2007年8月至2023年8月期间接受RAS治疗的早期NSCLC（临床I期）患者进行了分析。根据人口统计学特征和病理分期，对接受RAL治疗的患者进行了1:3倾向评分匹配分析。主要终点为CSS、RR和LR。共回顾性纳入40例接受RAS治疗的患者。在匹配120例接受RAL治疗的患者后，发现术后并发症、中位手术时间或住院时间无显著差异。接受RAS治疗的患者与接受RAL治疗的患者具有可比的10年CSS（=0.90）和RR（=0.99），而RAS组患者的10年局部复发累积发生率（LR）为11.0%（95%CI：3.4-23.7%），RAL组患者为2.8%（95%CI：0.5-8.9%）（=0.08）。此外，RAL组获取的N1和N2淋巴结数量显著更多（分别为<0.0001和0.06），以及更多的N2站（=0.0001）。根据我们的经验，尽管RAS在某些早期NSCLC病例中可以确保与RAL相当的优异长期结果，但RAS组的局部复发率更高。
