Robotic lobectomy versus thoracoscopic lobectomy in treatment for clinical N0 lung malignant tumor≥3 cm: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SONG Weijian , HOU Yucheng , ZHANG Jianfeng , LUO Qingquan ,  ZHOU Qianjun

Department of Surgical Oncology, Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China;

Corresponding author：

ZHOU Qianjun, Email: zhouqj@sjtu.edu.cn

Keywords：

Robot-assisted thoracic surgery; video-assisted thoracoscopic surgery; lung malignant tumor; lobectomy; propensity score matching study

DOI：

10.7507/1007-4848.202112048

Video：

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Objective To investigate the effectiveness and safety of robotic lobectomy in clinical N0 lung malignant tumor≥3 cm. Methods We retrospectively analyzed the clinical data of 182 patients with lung malignant tumor≥3 cm receiving robotic or thoracoscopic lobectomy at Shanghai Chest Hospital in 2019. The patients were divided into a robotic surgery group (RATS group) and a thoracoscopic surgery group (VATS group). There were 39 males and 38 females with an average age of 60.55±8.59 years in the RATS group, and 51 males and 54 females with an average age of 61.58±9.30 years in the VATS group. A propensity score matching analysis was applied to compare the operative data between the two groups. Results A total of 57 patients were included in each group after the propensity score matching analysis. Patients in the RATS group had more groups of N1 lymph node dissected (2.53±0.83 groups vs. 2.07±0.88 groups, P=0.005) in comparison with the VATS group. No statistical difference was found in operation time, blood loss, postoperative hospital stay, number of N1 and N2 lymph nodes dissected, groups of N2 lymph node dissected, lymph node upstage rate or postoperative complications. The hospitalization cost of RATS was higher than that of VATS (P＜0.001). Conclusion In contrast with thoracoscopic lobectomy, robotic lobectomy has similar operative safety, and a thorough N1 lymphadenectomy in patients with clinical N0 lung malignant tumor≥3 cm.

Citation： SONG Weijian, HOU Yucheng, ZHANG Jianfeng, LUO Qingquan, ZHOU Qianjun. Robotic lobectomy versus thoracoscopic lobectomy in treatment for clinical N0 lung malignant tumor≥3 cm: A propensity score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(4): 436-442. doi: 10.7507/1007-4848.202112048 Copy

1.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
2.	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
3.	Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: Results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg, 2011, 141(3): 662-670.
4.	Ghaly G, Kamel M, Nasar A, et al. Video-assisted thoracoscopic surgery is a safe and effective alternative to thoracotomy for anatomical segmentectomy in patients with clinical stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2016, 101(2): 465-472.
5.	Aiolfi A, Nosotti M, Micheletto G, et al. Pulmonary lobectomy for cancer: Systematic review and network meta-analysis comparing open, video-assisted thoracic surgery, and robotic approach. Surgery, 2021, 169(2): 436-446.
6.	Ma J, Li X, Zhao S, et al. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for lung lobectomy or segmentectomy in patients with non-small cell lung cancer: A meta-analysis. BMC Cancer, 2021, 21(1): 498.
7.	Wu H, Jin R, Yang S, et al. Long-term and short-term outcomes of robot- versus video-assisted anatomic lung resection in lung cancer: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2021, 59(4): 732-740.
8.	刘伦旭, 车国卫, 蒲强, 等. 单向式全胸腔镜肺叶切除术. 中国胸心血管外科临床杂志, 2008, 24(3): 156-168.
9.	田禹, 黄佳, 陆佩吉, 等. 机器人辅助与胸腔镜辅助右肺上叶切除术治疗非小细胞肺癌的回顾性队列研究. 中国胸心血管外科临床杂志, 2020, 27(10): 1134-1139.
10.	Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Shimizu H, Okada M, et al. Thoracic and cardiovascular surgeries in Japan during 2017: Annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg, 2020, 68(4): 414-449.
11.	Huang L, Shen Y, Onaitis M. Comparative study of anatomic lung resection by robotic vs. video-assisted thoracoscopic surgery. J Thorac Dis, 2019, 11(4): 1243-1250.
12.	Mungo B, Hooker CM, Ho JS, et al. Robotic versus thoracoscopic resection for lung cancer: Early results of a new robotic program. J Laparoendosc Adv Surg Tech A, 2016, 26(4): 243-248.
13.	Hu J, Chen Y, Dai J, et al. Perioperative outcomes of robot-assisted vs video-assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta-analysis. Int J Med Robot, 2020, 16(5): 1-14.
14.	李重武, 黄佳, 李剑涛, 等. 连续1000例机器人辅助胸腔镜肺部手术回顾性分析. 中国胸心血管外科临床杂志, 2019, 26(1): 42-47.
15.	Cho JY, Leem CS, Kim Y, et al. Solid part size is an important predictor of nodal metastasis in lung cancer with a subsolid tumor. BMC Pulm Med, 2018, 18(1): 151.
16.	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.
17.	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, 2016, 64(4): 354-362.
18.	Williams AM, Zhao L, Grenda TR, et al. Higher long-term quality of life metrics after video-assisted thoracoscopic surgery lobectomy compared with robotic-assisted lobectomy. Ann Thorac Surg, 2020, S0003-4975(20): 30971-1.
19.	Liang H, Liang W, Zhao L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: A meta-analysis. Ann Surg, 2018, 268(2): 254-259.
20.	Wilson JL, Louie BE, Cerfolio RJ, et al. The prevalence of nodal upstaging during robotic lung resection in early stage non-small cell lung cancer. Ann Thorac Surg, 2014, 97(6): 1901-1906.
21.	Samayoa AX, Pezzi TA, Pezzi CM, et al. Rationale for a minimum number of lymph nodes removed with non-small cell lung cancer resection: Correlating the number of nodes removed with survival in 98, 970 patients. Ann Surg Oncol, 2016, 23(Suppl 5): 1005-1011.
22.	Liang W, He J, Shen Y, et al. Impact of examined lymph node count on precise staging and long-term survival of resected non-small-cell lung cancer: A population study of the US SEER database and a Chinese multi-institutional registry. J Clin Oncol, 2017, 35(11): 1162-1170.
23.	Kneuertz PJ, Cheufou DH, D'Souza DM, et al. Propensity-score adjusted comparison of pathologic nodal upstaging by robotic, video-assisted thoracoscopic, and open lobectomy for non-small cell lung cancer. J Thorac Cardiovasc Surg, 2019, 158(5): 1457-1466.
24.	Hennon MW, DeGraaff LH, Groman A, et al. The association of nodal upstaging with surgical approach and its impact on long-term survival after resection of non-small-cell lung cancer. Eur J Cardiothorac Surg, 2020, 57(5): 888-895.
25.	Zirafa C, Aprile V, Ricciardi S, et al. Nodal upstaging evaluation in NSCLC patients treated by robotic lobectomy. Surg Endosc, 2019, 33(1): 153-158.
26.	Tang A, Raja S, Bribriesco AC, et al. Robotic approach offers similar nodal upstaging to open lobectomy for clinical stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2020, 110(2): 424-433.
27.	Huang J, Li C, Li H, et al. Robot-assisted thoracoscopic surgery versus thoracotomy for c-N2 stage NSCLC: Short-term outcomes of a randomized trial. Transl Lung Cancer Res, 2019, 8(6): 951-958.
28.	Yang S, Guo W, Chen X, et al. Early outcomes of robotic versus uniportal video-assisted thoracic surgery for lung cancer: A propensity score-matched study. Eur J Cardiothorac Surg, 2018, 53(2): 348-352.
29.	Haruki T, Takagi Y, Kubouchi Y, et al. Comparison between robot-assisted thoracoscopic surgery and video-assisted thoracoscopic surgery for mediastinal and hilar lymph node dissection in lung cancer surgery. Interact Cardiovasc Thorac Surg, 2021, 33(3): 409-417.
30.	Toker A, Özyurtkan MO, Demirhan Ö, et al. Lymph node dissection in surgery for lung cancer: Comparison of open vs. video-assisted vs. robotic-assisted approaches. Ann Thorac Cardiovasc Surg, 2016, 22(5): 284-290.
31.	Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stage Ⅰ nonsmall cell lung cancer: Comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265(2): 431-437.

1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
2. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
3. Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: Results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg, 2011, 141(3): 662-670.
4. Ghaly G, Kamel M, Nasar A, et al. Video-assisted thoracoscopic surgery is a safe and effective alternative to thoracotomy for anatomical segmentectomy in patients with clinical stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2016, 101(2): 465-472.
5. Aiolfi A, Nosotti M, Micheletto G, et al. Pulmonary lobectomy for cancer: Systematic review and network meta-analysis comparing open, video-assisted thoracic surgery, and robotic approach. Surgery, 2021, 169(2): 436-446.
6. Ma J, Li X, Zhao S, et al. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for lung lobectomy or segmentectomy in patients with non-small cell lung cancer: A meta-analysis. BMC Cancer, 2021, 21(1): 498.
7. Wu H, Jin R, Yang S, et al. Long-term and short-term outcomes of robot- versus video-assisted anatomic lung resection in lung cancer: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2021, 59(4): 732-740.
8. 刘伦旭, 车国卫, 蒲强, 等. 单向式全胸腔镜肺叶切除术. 中国胸心血管外科临床杂志, 2008, 24(3): 156-168.
9. 田禹, 黄佳, 陆佩吉, 等. 机器人辅助与胸腔镜辅助右肺上叶切除术治疗非小细胞肺癌的回顾性队列研究. 中国胸心血管外科临床杂志, 2020, 27(10): 1134-1139.
10. Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Shimizu H, Okada M, et al. Thoracic and cardiovascular surgeries in Japan during 2017: Annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg, 2020, 68(4): 414-449.
11. Huang L, Shen Y, Onaitis M. Comparative study of anatomic lung resection by robotic vs. video-assisted thoracoscopic surgery. J Thorac Dis, 2019, 11(4): 1243-1250.
12. Mungo B, Hooker CM, Ho JS, et al. Robotic versus thoracoscopic resection for lung cancer: Early results of a new robotic program. J Laparoendosc Adv Surg Tech A, 2016, 26(4): 243-248.
13. Hu J, Chen Y, Dai J, et al. Perioperative outcomes of robot-assisted vs video-assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta-analysis. Int J Med Robot, 2020, 16(5): 1-14.
14. 李重武, 黄佳, 李剑涛, 等. 连续1000例机器人辅助胸腔镜肺部手术回顾性分析. 中国胸心血管外科临床杂志, 2019, 26(1): 42-47.
15. Cho JY, Leem CS, Kim Y, et al. Solid part size is an important predictor of nodal metastasis in lung cancer with a subsolid tumor. BMC Pulm Med, 2018, 18(1): 151.
16. 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.
17. 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, 2016, 64(4): 354-362.
18. Williams AM, Zhao L, Grenda TR, et al. Higher long-term quality of life metrics after video-assisted thoracoscopic surgery lobectomy compared with robotic-assisted lobectomy. Ann Thorac Surg, 2020, S0003-4975(20): 30971-1.
19. Liang H, Liang W, Zhao L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: A meta-analysis. Ann Surg, 2018, 268(2): 254-259.
20. Wilson JL, Louie BE, Cerfolio RJ, et al. The prevalence of nodal upstaging during robotic lung resection in early stage non-small cell lung cancer. Ann Thorac Surg, 2014, 97(6): 1901-1906.
21. Samayoa AX, Pezzi TA, Pezzi CM, et al. Rationale for a minimum number of lymph nodes removed with non-small cell lung cancer resection: Correlating the number of nodes removed with survival in 98, 970 patients. Ann Surg Oncol, 2016, 23(Suppl 5): 1005-1011.
22. Liang W, He J, Shen Y, et al. Impact of examined lymph node count on precise staging and long-term survival of resected non-small-cell lung cancer: A population study of the US SEER database and a Chinese multi-institutional registry. J Clin Oncol, 2017, 35(11): 1162-1170.
23. Kneuertz PJ, Cheufou DH, D'Souza DM, et al. Propensity-score adjusted comparison of pathologic nodal upstaging by robotic, video-assisted thoracoscopic, and open lobectomy for non-small cell lung cancer. J Thorac Cardiovasc Surg, 2019, 158(5): 1457-1466.
24. Hennon MW, DeGraaff LH, Groman A, et al. The association of nodal upstaging with surgical approach and its impact on long-term survival after resection of non-small-cell lung cancer. Eur J Cardiothorac Surg, 2020, 57(5): 888-895.
25. Zirafa C, Aprile V, Ricciardi S, et al. Nodal upstaging evaluation in NSCLC patients treated by robotic lobectomy. Surg Endosc, 2019, 33(1): 153-158.
26. Tang A, Raja S, Bribriesco AC, et al. Robotic approach offers similar nodal upstaging to open lobectomy for clinical stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2020, 110(2): 424-433.
27. Huang J, Li C, Li H, et al. Robot-assisted thoracoscopic surgery versus thoracotomy for c-N2 stage NSCLC: Short-term outcomes of a randomized trial. Transl Lung Cancer Res, 2019, 8(6): 951-958.
28. Yang S, Guo W, Chen X, et al. Early outcomes of robotic versus uniportal video-assisted thoracic surgery for lung cancer: A propensity score-matched study. Eur J Cardiothorac Surg, 2018, 53(2): 348-352.
29. Haruki T, Takagi Y, Kubouchi Y, et al. Comparison between robot-assisted thoracoscopic surgery and video-assisted thoracoscopic surgery for mediastinal and hilar lymph node dissection in lung cancer surgery. Interact Cardiovasc Thorac Surg, 2021, 33(3): 409-417.
30. Toker A, Özyurtkan MO, Demirhan Ö, et al. Lymph node dissection in surgery for lung cancer: Comparison of open vs. video-assisted vs. robotic-assisted approaches. Ann Thorac Cardiovasc Surg, 2016, 22(5): 284-290.
31. Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stage Ⅰ nonsmall cell lung cancer: Comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265(2): 431-437.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Robotic lobectomy versus thoracoscopic lobectomy in treatment for clinical N0 lung malignant tumor≥3 cm: A propensity score matching study

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