Nakamura Ryuji, Okuda Katsuhiro, Hosokawa Shin, Yobita Shogo, Chiba Kensuke, Oda Risa, Tatematsu Tsutomu, Yokota Keisuke
Department of Thoracic and Pediatric Surgery, Graduate School of Medical Sciences and Medical School, Nagoya City University, Nagoya, Japan.
J Thorac Dis. 2025 Aug 31;17(8):5429-5441. doi: 10.21037/jtd-2025-553. Epub 2025 Aug 11.
Minimally invasive surgery, including video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), has been widely performed for non-small cell lung cancer (NSCLC). Several studies have reported the clinical benefits of RATS for early-stage NSCLC. However, the application of RATS in the more advanced stage NSCLC remains controversial. This retrospective study aimed to compare the perioperative and survival outcomes of patients with pathological stage II-IIIB NSCLC who underwent lobectomy by VATS or RATS.
This retrospective study identified patients with pathological stage II-IIIB NSCLC who underwent lobectomy via VATS or RATS at Nagoya City University Hospital between 2017 and 2023. Perioperative outcomes, disease-free survival (DFS) and overall survival (OS) were assessed.
In total, 145 patients (VATS, n=109; RATS, n=36) were included. After propensity score matching (PSM), there were 62 patients in the VATS group and 31 patients in the RATS group. In the PSM cohort analysis, blood loss was lower [109 mL, interquartile range (IQR), 67-168 52 mL, IQR, 25-102; P=0.003] and the length of postoperative hospital stay was shorter (5 days, IQR, 5-8 5 days, IQR, 4-5; P=0.01) in the RATS group. The 3-year DFS rates were 44.2% in the VATS group and 56.0% in the RATS group (P=0.12). The 3-year OS rates were 68.1% in the VATS group and 72.5% in the RATS group (P=0.30).
Even in cases of pathological stage II-IIIB NSCLC, RATS is feasible and is associated with comparable survival and perioperative outcomes to VATS. Additional multicenter studies are needed to ensure the representativeness of this study.
包括电视辅助胸腔镜手术（VATS）和机器人辅助胸腔镜手术（RATS）在内的微创手术已广泛应用于非小细胞肺癌（NSCLC）的治疗。多项研究报道了RATS治疗早期NSCLC的临床益处。然而，RATS在更晚期NSCLC中的应用仍存在争议。这项回顾性研究旨在比较接受VATS或RATS肺叶切除术的病理II-IIIB期NSCLC患者的围手术期和生存结果。
这项回顾性研究纳入了2017年至2023年在名古屋市立大学医院接受VATS或RATS肺叶切除术的病理II-IIIB期NSCLC患者。评估围手术期结果、无病生存期（DFS）和总生存期（OS）。
共纳入145例患者（VATS组109例，RATS组36例）。倾向评分匹配（PSM）后，VATS组有62例患者，RATS组有31例患者。在PSM队列分析中，RATS组的失血量更低[109 mL，四分位数间距（IQR），67-168 vs 52 mL，IQR，25-102；P=0.003]，术后住院时间更短（5天，IQR，5-8 vs 5天，IQR，4-5；P=0.01）。VATS组的3年DFS率为44.2%，RATS组为56.0%（P=0.12）。VATS组的3年OS率为68.1%，RATS组为72.5%（P=0.30）。
即使在病理II-IIIB期NSCLC病例中，RATS也是可行的，并且与VATS具有相当的生存和围手术期结果。需要更多的多中心研究来确保本研究的代表性。
