Perioperative outcomes of robot-assisted versus video-assisted left upper lobectomy in non-small cell lung cancer: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHENG Ming ^1,2 , LIU Deyu ³ , WU Qiong ² , XU Shiguang ² , XU Wei ² , LI Bo ² , DING Renquan ² , WANG Feifei ² ,  WANG Shumin ²

1. Graduate Training Base of General Hospital of Northern Theater Command, Dalian Medical University, Shenyang, 110016, P. R. China;
2. Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;
3. Department of Thoracic Surgery, The Second Hospital of Dalian Medical Univercity, Dalian, 116023, Liaoning, P. R. China;

Corresponding?author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Da Vinci robot; video-assisted thoracoscopic surgery; left upper lobectomy; non-small cell lung cancer

DOI：

10.7507/1007-4848.202112005

Video：

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Objective To summarize the efficacy of robot-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) in the treatment of left upper lobectomy for non-small cell lung cancer. Methods The clinical data of patients with non-small cell lung cancer who underwent left upper lobectomy with RATS or VATS in our center from January 2019 to October 2021 were retrospectively analyzed. The patients were divided into two groups according to surgical methods: a RATS group and a VATS group. The baseline clinical data and results were compared between the two groups. Results A total of 145 patients were included. There were 78 males and 67 females with a mean age of 59.9 years. There were 63 patients in the RATS group and 82 patients in the VATS group. There was no death within 30 days after operation in both groups. In the RATS group, the drainage volume on the second postoperative day (233.49±83.94 mL vs. 284.88±120.21 mL, P=0.003), total operative time (126.94±29.50 min vs. 181.59±61.51 min, P=0.000), intraoperative resection time of the left upper lobe (76.48±27.52 min vs. 107.23±47.84 min, P=0.000), intraoperative blood loss (P=0.000), and conversion rate to thoracotomy (P=0.018) were significantly better than those in the VATS group. The group (5.41±0.94 groups vs. 4.83±1.31 groups, P=0.002) and number (18.27±7.39 vs. 12.76±6.54, P=0.000) of dissected lymph nodes in the RATS group were significantly more than those in the VATS group. The differences in the drainage volume on the first day after operation, postoperative intubation time, postoperative hospital stay or postoperative complications between the two groups were not statistically significant (P>0.05). Conclusion The application of RATS in the left upper lobectomy for non-small cell lung cancer is safe and feasible, and has obvious advantages over VATS.

Citation： CHENG Ming, LIU Deyu, WU Qiong, XU Shiguang, XU Wei, LI Bo, DING Renquan, WANG Feifei, WANG Shumin. Perioperative outcomes of robot-assisted versus video-assisted left upper lobectomy in non-small cell lung cancer: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(5): 672-677. doi: 10.7507/1007-4848.202112005 Copy

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2.	Detterbeck FC, Lewis SZ, Diekemper R, et al. Executive summary: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): 7S-37S.
3.	Swanson SJ, Herndon JE, D'Amico TA, et al. Video-assisted thoracic surgery lobectomy: Report of CALGB 39802—A prospective, multi-institution feasibility study. J Clin Oncol, 2007, 25(31): 4993-4997.
4.	Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: A propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg, 2010, 139(2): 366-378.
5.	王述民. 達芬奇機器人在肺癌根治術中的應用現狀及展望. 中國腫瘤, 2014, 23(9): 736-742.
6.	馬征, 岳韋名, 高存, 等. 基于傾向性評分匹配法的機器人與胸腔鏡輔助胸外科手術治療肺癌的近期效果比較. 中華胸部外科電子雜志, 2020, 7(4): 208-213.
7.	Louie BE, Wilson JL, Kim S, et al. Comparison of video-assisted thoracoscopic surgery and robotic approaches for clinical stage Ⅰ and stageⅡ non-small cell lung cancer using the Society of Thoracic Surgeons Database. Ann Thorac Surg, 2016, 102(3): 917-924.
8.	Radkani P, Joshi D, Barot T, et al. Robotic video-assisted thoracoscopic lung resection for lung tumors: A community tertiary care center experience over four years. Surg Endosc, 2016, 30(2): 619-624.
9.	Melfi FM, Fanucchi O, Davini F, et al. VATS-based approach for robotic lobectomy. Thorac Surg Clin, 2014, 24(2): 143-149.
10.	Wei B, Eldaif SM, Cerfolio RJ. Robotic lung resection for non-small cell lung cancer. Surg Oncol Clin N Am, 2016, 25(3): 515-531.
11.	查鵬, 陳艷艷, 張蔚萱, 等. 左右側胸腔鏡肺上葉切除術后胸腔引流情況的對照研究. 中國微創外科雜志, 2021, 21(3): 253-256.
12.	何建行, 楊運有, 陳滿蔭, 等. 胸腔鏡肺葉切除術. 中華外科雜志, 1996, 34(2): 76-78.
13.	鄒衛, 許棟生, 蘇宜江, 等. 左肺上葉切除的血管處理. 中華胸心血管外科雜志, 2006, 22(1): 57.
14.	王述民, 童向東, 劉博, 等. 達芬奇機器人左肺上葉切除術和淋巴結清除術治療非小細胞肺癌. 中國胸心血管外科臨床雜志, 2015, 22(3): 215-219.
15.	Whitson BA, D'Cunha J, Andrade RS, et al. Thoracoscopic versus thoracotomy approaches to lobectomy: Differential impairment of cellular immunity. Ann Thorac Surg, 2008, 86(6): 1735-1744.
16.	張捷, 王長利, 孫酉甦. 機器人時代的胸部腫瘤外科. 中華醫學雜志, 2006, 86(33): 2372-2374.
17.	張真發, 岳東升, 王勐, 等. 達芬奇機器人系統與胸腔鏡在肺癌根治術中的近期療效比較及經驗探討. 中國腫瘤臨床, 2021, 48(10): 511-515.
18.	馬克峰, 初向陽. 機器人肺葉切除術. 中華胸心血管外科雜志, 2015, 31(5): 314-316.
19.	Li JT, Liu PY, Huang J, et al. Perioperative outcomes of radical lobectomies using robotic-assisted thoracoscopic technique vs. video-assisted thoracoscopic technique: Retrospective study of 1, 075 consecutive p-stageⅠnon-small cell lung cancer cases. J Thorac Dis, 2019, 11(3): 882-891.
20.	茍云久, 王兵, 金大成, 等. 達芬奇機器人與胸腔鏡在肺癌淋巴結整塊清掃中的對比研究. 機器人外科學雜志, 2020, 1(2): 134-140.
21.	McKenna RJ, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: Experience with 1, 100 cases. Ann Thorac Surg, 2006, 81(2): 421-425.
22.	Merritt RE, Kneuertz PJ, D'Souza DM. Successful transition to robotic-assisted lobectomy with previous proficiency in thoracoscopic lobectomy. Innovations (Phila), 2019, 14(3): 263-271.
23.	Cerfolio RJ, Bryant AS, Skylizard L, et al. Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms. J Thorac Cardiovasc Surg, 2011, 142(4): 740-746.
24.	Licht PB, J?rgensen OD, Ladegaard L, et al. A national study of nodal upstaging after thoracoscopic versus open lobectomy for clinical stageⅠlung cancer. Ann Thorac Surg, 2013, 96(3): 943-949.

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin, 2017, 67(1): 7-30.
2. Detterbeck FC, Lewis SZ, Diekemper R, et al. Executive summary: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): 7S-37S.
3. Swanson SJ, Herndon JE, D'Amico TA, et al. Video-assisted thoracic surgery lobectomy: Report of CALGB 39802—A prospective, multi-institution feasibility study. J Clin Oncol, 2007, 25(31): 4993-4997.
4. Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: A propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg, 2010, 139(2): 366-378.
5. 王述民. 達芬奇機器人在肺癌根治術中的應用現狀及展望. 中國腫瘤, 2014, 23(9): 736-742.
6. 馬征, 岳韋名, 高存, 等. 基于傾向性評分匹配法的機器人與胸腔鏡輔助胸外科手術治療肺癌的近期效果比較. 中華胸部外科電子雜志, 2020, 7(4): 208-213.
7. Louie BE, Wilson JL, Kim S, et al. Comparison of video-assisted thoracoscopic surgery and robotic approaches for clinical stage Ⅰ and stageⅡ non-small cell lung cancer using the Society of Thoracic Surgeons Database. Ann Thorac Surg, 2016, 102(3): 917-924.
8. Radkani P, Joshi D, Barot T, et al. Robotic video-assisted thoracoscopic lung resection for lung tumors: A community tertiary care center experience over four years. Surg Endosc, 2016, 30(2): 619-624.
9. Melfi FM, Fanucchi O, Davini F, et al. VATS-based approach for robotic lobectomy. Thorac Surg Clin, 2014, 24(2): 143-149.
10. Wei B, Eldaif SM, Cerfolio RJ. Robotic lung resection for non-small cell lung cancer. Surg Oncol Clin N Am, 2016, 25(3): 515-531.
11. 查鵬, 陳艷艷, 張蔚萱, 等. 左右側胸腔鏡肺上葉切除術后胸腔引流情況的對照研究. 中國微創外科雜志, 2021, 21(3): 253-256.
12. 何建行, 楊運有, 陳滿蔭, 等. 胸腔鏡肺葉切除術. 中華外科雜志, 1996, 34(2): 76-78.
13. 鄒衛, 許棟生, 蘇宜江, 等. 左肺上葉切除的血管處理. 中華胸心血管外科雜志, 2006, 22(1): 57.
14. 王述民, 童向東, 劉博, 等. 達芬奇機器人左肺上葉切除術和淋巴結清除術治療非小細胞肺癌. 中國胸心血管外科臨床雜志, 2015, 22(3): 215-219.
15. Whitson BA, D'Cunha J, Andrade RS, et al. Thoracoscopic versus thoracotomy approaches to lobectomy: Differential impairment of cellular immunity. Ann Thorac Surg, 2008, 86(6): 1735-1744.
16. 張捷, 王長利, 孫酉甦. 機器人時代的胸部腫瘤外科. 中華醫學雜志, 2006, 86(33): 2372-2374.
17. 張真發, 岳東升, 王勐, 等. 達芬奇機器人系統與胸腔鏡在肺癌根治術中的近期療效比較及經驗探討. 中國腫瘤臨床, 2021, 48(10): 511-515.
18. 馬克峰, 初向陽. 機器人肺葉切除術. 中華胸心血管外科雜志, 2015, 31(5): 314-316.
19. Li JT, Liu PY, Huang J, et al. Perioperative outcomes of radical lobectomies using robotic-assisted thoracoscopic technique vs. video-assisted thoracoscopic technique: Retrospective study of 1, 075 consecutive p-stageⅠnon-small cell lung cancer cases. J Thorac Dis, 2019, 11(3): 882-891.
20. 茍云久, 王兵, 金大成, 等. 達芬奇機器人與胸腔鏡在肺癌淋巴結整塊清掃中的對比研究. 機器人外科學雜志, 2020, 1(2): 134-140.
21. McKenna RJ, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: Experience with 1, 100 cases. Ann Thorac Surg, 2006, 81(2): 421-425.
22. Merritt RE, Kneuertz PJ, D'Souza DM. Successful transition to robotic-assisted lobectomy with previous proficiency in thoracoscopic lobectomy. Innovations (Phila), 2019, 14(3): 263-271.
23. Cerfolio RJ, Bryant AS, Skylizard L, et al. Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms. J Thorac Cardiovasc Surg, 2011, 142(4): 740-746.
24. Licht PB, J?rgensen OD, Ladegaard L, et al. A national study of nodal upstaging after thoracoscopic versus open lobectomy for clinical stageⅠlung cancer. Ann Thorac Surg, 2013, 96(3): 943-949.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Perioperative outcomes of robot-assisted versus video-assisted left upper lobectomy in non-small cell lung cancer: A retrospective cohort study

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