Clinical analysis for the short-term outcome of Da Vinci robotic-assisted left upper lobectomy for lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TONG Liping , ZHENG Xiaoqing , DUAN Hongtao , LIU Honggang , DONG Xiaoping , ZHANG Yong ,  YAN Xiaolong

Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, P.R.China;

Corresponding author：

YAN Xiaolong, Email: 47260934@qq.com

Keywords：

Lung cancer; minimally invasive; Da Vinci surgical system; left upper lobectomy

DOI：

10.7507/1007-4848.201905019

Video：

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Objective To summarize the clinical experience of Da Vinci robotic-assisted left upper lobectomy for treating lung cancer.Methods We retrospectively analyzed the perioperative data of 33 patients with primary lung cancer who underwent Da Vinci robotic-assisted left upper lobectomy between December 2016 and December 2018 in our hospital. Meanwhile, the perioperative data of 41 patients with lung cancer who underwent video-assisted thoracoscopic left upper lobectomy during the same period by the same surgeon were studied as a control group. The resection was followed by the principle of "from back down to front up" way. Systemic lymph node dissection including No.4-9 was performed for all patients.Results All patients received successful surgery with no case of conversion to thoracotomy and perioperative death. Comparing to video-assisted thoracoscopic surgery, the Da Vinci robotic-assisted left upper lobectomy had longer operating time (191.21±61.77 min vs. 154.51±38.81 min, P=0.003), more cost (82 307.75±11 859.03 yuan vs. 58 966.57±5 640.07 yuan, P=0.000), shorter chest tube duration (4.58±1.77 d vs. 5.41±1.52 d, P=0.031) and postoperative hospital stay (6.48±1.82 d vs. 7.66±2.12 d, P=0.014). However, there was no significant difference between the two groups regarding to blood loss, lymph node dissection, postoperative pain score, total chest drainage volume, chest drainage volume per day and the rate of pulmonary complications.Conclusion The Da Vinci robotic-assisted left upper lobectomy for treating lung cancer is safe and more minimally invasive, but more expensive.

Citation： TONG Liping, ZHENG Xiaoqing, DUAN Hongtao, LIU Honggang, DONG Xiaoping, ZHANG Yong, YAN Xiaolong. Clinical analysis for the short-term outcome of Da Vinci robotic-assisted left upper lobectomy for lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(2): 183-189. doi: 10.7507/1007-4848.201905019 Copy

1.	Chen W, Zheng R, Baade PD, et al. Cancer Statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2.	Lemjabbar-Alaoui H, Hassan OU, Yang YW, et al. Lung cancer: biology and treatment options. Biochim Biophys Acta, 2015, 1856(2): 189-210.
3.	Novellis P, Alloisio M, Vanni E, et al. Robotic lung cancer surgery: review of experience and costs. J Vis Surg, 2017, 3: 39.
4.	史博文, 孙冰生, 岳东升, 等. 达芬奇手术系统与胸腔镜在肺癌根治术中的对比分析. 肿瘤防治研究, 2018, 45(2): 91-95.
5.	Pardolesi A, Bertolaccini L, Brandolini J, et al. Four arms robotic-assisted pulmonary resection—left upper lobectomy: how to do it. J Vis Surg, 2018, 4: 109.
6.	Kent M, Wang T, Whyte R, et al. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg, 2014, 97(1): 236-424.
7.	李文涛, 姜格宁, 高文, 等. 序贯式全胸腔镜肺叶切除术的临床应用. 中华外科杂志, 2011, 49(5): 468-469.
8.	Veronesi G, Novellis P, Voulaz E, et al. Robot-assisted surgery for lung cancer: State of the art and perspectives. Lung Cancer, 2016, 101: 28-34.
9.	同李平, 郑晓庆, 刘红岗, 等. “双微孔”的三孔胸腔镜肺叶切除术200例临床分析. 中国胸心血管外科临床杂志, 2019, 26(4): 369-373.
10.	Tong L, Zheng X, Duan H, et al. The feasibility and efficacy of two micro-portal videoassisted thoracic surgery in pulmonary lobectomy for lung cancer. J Thorac Dis, 2018, 10(10): 5898-5903.
11.	Liu C, Pu Q, Guo C, et al. Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer suegery. BMC Surg, 2015, 15: 38.
12.	李彩伟, 徐美青, 徐广文, 等. 单孔与三孔胸腔镜肺部手术后急慢性疼痛的对比研究. 中国肺癌杂志, 2017, 21(4): 279-284.
13.	Detterdeck F, Molins L. Video-assisted thoracic surgery and open chest surgery in lung cancer treatment: present and future. J Vis Surg, 2016, 2: 173.
14.	Guerrero WG, Gonzalez-Rivas D. Multiportal video-assisted thoracic surgery, uniportal video-assisted thoracic surgery and minimally invasive open chest surgery-seletion criteria. J Vis Surg, 2017, 3: 56.
15.	刘奎, 李力元, 王茂龙, 等. 胸腔镜肺叶切除术难点体会. 临床肺科杂志, 2012, 17(7): 1185-1186.
16.	McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg, 2006, 81(2): 421-425.
17.	王述民, 汪诚风. 浅谈达芬奇机器人手术系统与电视胸腔镜系统在胸外科肺叶切除术中优劣. 临床军医杂志, 2016, 44(6): 551-555.
18.	Melfi FM, Menconi GF, Mariani AM, et al. Early experience with robotic technology forthoracoscopic surgery. Eur J Cardiothorac Surg, 2002, 21(5): 864-868.
19.	Mahieu J, Rinieri P, Bubenheim M, et al. Robot-assisted thoracoscopic surgery versus video-assisted thoracoscopic surgery for lung lobectomy:can a robotic approach improve short-term outcomes and operative safety? Thorac Cardiovasc Surg, 2015, 64(4): 354-362.
20.	Wei S, Chen M, Chen N, et al. Feasibility and safety of robot-assisted thoracicsurgery for lung lobectomy in patients with non-small cell lung cancer: a systematic review and meta-analysis. World J Surg Oncol, 2017, 15(1): 98.
21.	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.
22.	Louie BE, Farivar AS, Aye RW, et al. Early experience with robotic lung resection results in similar operative outcomes and morbidity when compared with matched video-assisted thoracoscopic surgery cases. Ann Thorac Surg, 2012, 93(5): 1598-1604.
23.	Veronesi G, Galetta D, Maisonneuve P, et al. Four-arm robotic lobectomy for the treatment of early-stage lung cancer. J Thorac Cardiovasc Surg, 2010, 140: 19-25.
24.	Toker A, Kaba E, Ayalp K, et al. Robotic lung resections: video-assisted thoracic surgery based approach. J Vis Surg, 2017, 3: 15.
25.	王述民, 童向东, 刘博, 等. 达芬奇机器人左肺上叶切除术和淋巴结清除术治疗非小细胞肺癌. 中国胸心血管外科临床杂志, 2015, 22(3): 215-219.
26.	王述民, 许世广, 童向东, 等. 机器人肺叶切除术治疗非小细胞肺癌. 中国胸心血管外科临床杂志, 2013, 20(3): 308-311.
27.	刘伦旭, 车国卫, 蒲强, 等. 单向式全胸腔镜肺叶切除术. 中华胸心血管外科杂志, 2008, 24(3): 156-158.
28.	邹卫, 许栋生, 苏宜江, 等. 左肺上叶切除的血管处理. 中华胸心血管外科杂志志, 2006, 22(1): 57.
29.	许世广, 刘星池, 王希龙, 等. 应用达芬奇机器人手术系统肺切除技术总结. 中华胸部外科电子杂志, 2016, 3(2): 77-82.
30.	庞作良, 吴斌, 高胜利, 等. 左肺上叶癌的外科治疗. 新疆医科大学学报, 2006, 29(10): 948-949.
31.	马超, 孙耀光, 田文鑫, 等. 单操作孔全胸腔镜左肺上叶切除术 246 例. 中国微创外科杂志, 2017, 17(8): 680-687.
32.	Duan H, Tong L, Zhu Y, et al. Secondary resection tracheal was facilitated in robot-assisted left pneumonectomy. J Thorac Dis, 2018, 10(12): 7005-7008.
33.	Reddy RM, Gorrepati ML, Oh DS, et al. Robotic-assisted versus thoracoscopic lobectomy outcomes from high-volume thoracic surgeons. Ann Thorac Surg, 2018, 106(3): 902-908.
34.	Agzarian J, Fahim C, Shargall Y, et al. The use of robotic-assisted thoracic surgery for lung resection: A comprehensive systematic review. Semin Thorac Cardiovasc Surg, 2016, 28(1): 182-192.
35.	Scott J. Swanson, Daniel L. Miller, Robert Joseph McKenna, et al Comparing robot-assisted thoracic surgical lobectomy with conventional video-assisted thoracic surgical lobectomy and wedge resection: Results from a multihospital database (Premier). J Thorac Cardiovasc Surg, 2014, 147: 929-937.
36.	马继龙, 金大成, 韩松辰, 等. 早期肺癌患者行达芬奇机器人与胸腔镜肺癌根治术的病例对照研究. 中国胸心血管外科临床杂志, 2019, 26(1): 48-52.
37.	代锋, 许世广, 徐惟, 等. 达芬奇机器人与电视胸腔镜辅助非小细胞肺癌根治术近期疗效配对的病例对照研究. 中国肺癌杂志, 2018, 21(3): 206-211.
38.	王述民. 达芬奇机器人在肺癌根治术中的应用现状及展望. 中国肿瘤, 2014, 23(9): 736-742.

1. Chen W, Zheng R, Baade PD, et al. Cancer Statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2. Lemjabbar-Alaoui H, Hassan OU, Yang YW, et al. Lung cancer: biology and treatment options. Biochim Biophys Acta, 2015, 1856(2): 189-210.
3. Novellis P, Alloisio M, Vanni E, et al. Robotic lung cancer surgery: review of experience and costs. J Vis Surg, 2017, 3: 39.
4. 史博文, 孙冰生, 岳东升, 等. 达芬奇手术系统与胸腔镜在肺癌根治术中的对比分析. 肿瘤防治研究, 2018, 45(2): 91-95.
5. Pardolesi A, Bertolaccini L, Brandolini J, et al. Four arms robotic-assisted pulmonary resection—left upper lobectomy: how to do it. J Vis Surg, 2018, 4: 109.
6. Kent M, Wang T, Whyte R, et al. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg, 2014, 97(1): 236-424.
7. 李文涛, 姜格宁, 高文, 等. 序贯式全胸腔镜肺叶切除术的临床应用. 中华外科杂志, 2011, 49(5): 468-469.
8. Veronesi G, Novellis P, Voulaz E, et al. Robot-assisted surgery for lung cancer: State of the art and perspectives. Lung Cancer, 2016, 101: 28-34.
9. 同李平, 郑晓庆, 刘红岗, 等. “双微孔”的三孔胸腔镜肺叶切除术200例临床分析. 中国胸心血管外科临床杂志, 2019, 26(4): 369-373.
10. Tong L, Zheng X, Duan H, et al. The feasibility and efficacy of two micro-portal videoassisted thoracic surgery in pulmonary lobectomy for lung cancer. J Thorac Dis, 2018, 10(10): 5898-5903.
11. Liu C, Pu Q, Guo C, et al. Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer suegery. BMC Surg, 2015, 15: 38.
12. 李彩伟, 徐美青, 徐广文, 等. 单孔与三孔胸腔镜肺部手术后急慢性疼痛的对比研究. 中国肺癌杂志, 2017, 21(4): 279-284.
13. Detterdeck F, Molins L. Video-assisted thoracic surgery and open chest surgery in lung cancer treatment: present and future. J Vis Surg, 2016, 2: 173.
14. Guerrero WG, Gonzalez-Rivas D. Multiportal video-assisted thoracic surgery, uniportal video-assisted thoracic surgery and minimally invasive open chest surgery-seletion criteria. J Vis Surg, 2017, 3: 56.
15. 刘奎, 李力元, 王茂龙, 等. 胸腔镜肺叶切除术难点体会. 临床肺科杂志, 2012, 17(7): 1185-1186.
16. McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg, 2006, 81(2): 421-425.
17. 王述民, 汪诚风. 浅谈达芬奇机器人手术系统与电视胸腔镜系统在胸外科肺叶切除术中优劣. 临床军医杂志, 2016, 44(6): 551-555.
18. Melfi FM, Menconi GF, Mariani AM, et al. Early experience with robotic technology forthoracoscopic surgery. Eur J Cardiothorac Surg, 2002, 21(5): 864-868.
19. Mahieu J, Rinieri P, Bubenheim M, et al. Robot-assisted thoracoscopic surgery versus video-assisted thoracoscopic surgery for lung lobectomy:can a robotic approach improve short-term outcomes and operative safety? Thorac Cardiovasc Surg, 2015, 64(4): 354-362.
20. Wei S, Chen M, Chen N, et al. Feasibility and safety of robot-assisted thoracicsurgery for lung lobectomy in patients with non-small cell lung cancer: a systematic review and meta-analysis. World J Surg Oncol, 2017, 15(1): 98.
21. 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.
22. Louie BE, Farivar AS, Aye RW, et al. Early experience with robotic lung resection results in similar operative outcomes and morbidity when compared with matched video-assisted thoracoscopic surgery cases. Ann Thorac Surg, 2012, 93(5): 1598-1604.
23. Veronesi G, Galetta D, Maisonneuve P, et al. Four-arm robotic lobectomy for the treatment of early-stage lung cancer. J Thorac Cardiovasc Surg, 2010, 140: 19-25.
24. Toker A, Kaba E, Ayalp K, et al. Robotic lung resections: video-assisted thoracic surgery based approach. J Vis Surg, 2017, 3: 15.
25. 王述民, 童向东, 刘博, 等. 达芬奇机器人左肺上叶切除术和淋巴结清除术治疗非小细胞肺癌. 中国胸心血管外科临床杂志, 2015, 22(3): 215-219.
26. 王述民, 许世广, 童向东, 等. 机器人肺叶切除术治疗非小细胞肺癌. 中国胸心血管外科临床杂志, 2013, 20(3): 308-311.
27. 刘伦旭, 车国卫, 蒲强, 等. 单向式全胸腔镜肺叶切除术. 中华胸心血管外科杂志, 2008, 24(3): 156-158.
28. 邹卫, 许栋生, 苏宜江, 等. 左肺上叶切除的血管处理. 中华胸心血管外科杂志志, 2006, 22(1): 57.
29. 许世广, 刘星池, 王希龙, 等. 应用达芬奇机器人手术系统肺切除技术总结. 中华胸部外科电子杂志, 2016, 3(2): 77-82.
30. 庞作良, 吴斌, 高胜利, 等. 左肺上叶癌的外科治疗. 新疆医科大学学报, 2006, 29(10): 948-949.
31. 马超, 孙耀光, 田文鑫, 等. 单操作孔全胸腔镜左肺上叶切除术 246 例. 中国微创外科杂志, 2017, 17(8): 680-687.
32. Duan H, Tong L, Zhu Y, et al. Secondary resection tracheal was facilitated in robot-assisted left pneumonectomy. J Thorac Dis, 2018, 10(12): 7005-7008.
33. Reddy RM, Gorrepati ML, Oh DS, et al. Robotic-assisted versus thoracoscopic lobectomy outcomes from high-volume thoracic surgeons. Ann Thorac Surg, 2018, 106(3): 902-908.
34. Agzarian J, Fahim C, Shargall Y, et al. The use of robotic-assisted thoracic surgery for lung resection: A comprehensive systematic review. Semin Thorac Cardiovasc Surg, 2016, 28(1): 182-192.
35. Scott J. Swanson, Daniel L. Miller, Robert Joseph McKenna, et al Comparing robot-assisted thoracic surgical lobectomy with conventional video-assisted thoracic surgical lobectomy and wedge resection: Results from a multihospital database (Premier). J Thorac Cardiovasc Surg, 2014, 147: 929-937.
36. 马继龙, 金大成, 韩松辰, 等. 早期肺癌患者行达芬奇机器人与胸腔镜肺癌根治术的病例对照研究. 中国胸心血管外科临床杂志, 2019, 26(1): 48-52.
37. 代锋, 许世广, 徐惟, 等. 达芬奇机器人与电视胸腔镜辅助非小细胞肺癌根治术近期疗效配对的病例对照研究. 中国肺癌杂志, 2018, 21(3): 206-211.
38. 王述民. 达芬奇机器人在肺癌根治术中的应用现状及展望. 中国肿瘤, 2014, 23(9): 736-742.

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Clinical analysis for the short-term outcome of Da Vinci robotic-assisted left upper lobectomy for lung cancer

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