Da-Vinci robot-assisted thoracic surgery versus video-assisted thoracic surgery for non-small cell lung cancer: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZENG Weiqiang ¹ ,  GOU Yunjiu ² , BAI Xiangdou ¹

1. The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
2. Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;

Corresponding author：

GOU Yunjiu, Email: gouyunjiu@163.com

Keywords：

Da-Vinci robot-assisted thoracic surgery; video-assisted thoracic surgery; lung cancer; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202203008

Video：

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Objective To compare the surgical efficacy of Da-Vinci robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for non-small cell lung cancer (NSCLC). Methods Online databases including PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP and CBM from inception to 18 February, 2022 were searched by two researchers independently. The references of related studies were also searched to re-enroll the potential studies. The quality of the studies was evaluated with Newcastle-Ottawa Scale (NOS). The meta-analysis was performed by RevMan 5.3. Results A total of 43 studies including 33 089 patients were enrolled in the final study. The NOS scores of the included studies were ≥6 points. The results of meta-analysis showed that the operation time was longer [MD=8.50, 95%CI (1.59, 15.41), P=0.020], the blood loss was less [MD=−46.58, 95%CI (−62.86, −30.29), P＜0.001], the dissected lymph nodes stations were more [MD=0.67, 95%CI (0.40, 0.93), P＜0.001], the dissected lymph nodes were more [MD=2.39, 95%CI (1.43, 3.36), P＜0.001], the conversion rate was lower [OR=0.52, 95%CI (0.46, 0.59), P＜0.001], the time of chest tube drainage was shorter [MD=−0.35, 95%CI (−0.58, −0.11), P=0.004], the length of hospital stay was shorter [MD=−0.32, 95%CI (−0.45, −0.19), P＜0.001], and the recurrence rate was lower [OR=0.51, 95%CI (0.36, 0.72), P＜0.001] in the RATS group than those in the VATS group. The rate of overall postoperative complications [OR=0.95, 95%CI (0.89, 1.01), P=0.110] and postoperative mortality rate [OR=0.85, 95%CI (0.62, 1.16), P=0.300] were not significantly different between the two groups. Conclusion Compared with VATS, although RATS prolongs the operation time, it does not increase the incidence of postoperative complications and mortality rates. Moreover, RATS can dissect more lymph nodes, effectively control intraoperative bleeding, shorten the duration of chest drainage tube indwelling and shorten the postoperative hospital stay to a certain extent.

Citation： ZENG Weiqiang, GOU Yunjiu, BAI Xiangdou. Da-Vinci robot-assisted thoracic surgery versus video-assisted thoracic surgery for non-small cell lung cancer: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 447-457. doi: 10.7507/1007-4848.202203008 Copy

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1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 赵云鹏, 丛波, 赵小刚, 等. 全胸腔镜肺叶切除术与开胸肺叶切除术淋巴结清扫及生存的Meta分析. 中华胸心血管外科杂志, 2014, 30(8): 467-472.
3. Lee BE, Shapiro M, Rutledge JR, et al. Nodal upstaging in robotic and video assisted thoracic surgery lobectomy for clinical N0 lung cancer. Ann Thorac Surg, 2015, 100(1): 229-233.
4. Bao F, Zhang C, Yang Y, et al. Comparison of robotic and video-assisted thoracic surgery for lung cancer: A propensity-matched analysis. J Thorac Dis, 2016, 8(7): 1798-1803.
5. Oh DS, Reddy RM, Gorrepati ML, et al. Robotic-assisted, video-assisted thoracoscopic and open lobectomy: Propensity-matched analysis of recent premier data. Ann Thorac Surg, 2017, 104(5): 1733-1740.
6. 刘星池, 许世广, 刘博, 等. Ⅰ期非小细胞肺癌达芬奇机器人手术的疗效分析. 中国肺癌杂志, 2018, 21(11): 849-856.
7. 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.
8. 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.
9. 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.
10. Li C, Hu Y, Huang J, et al. Comparison of robotic-assisted lobectomy with video-assisted thoracic surgery for stage ⅡB-ⅢA non-small cell lung cancer. Transl Lung Cancer Res, 2019, 8(6): 820-828.
11. 同李平, 郑晓庆, 段鸿涛, 等. 达芬奇机器人左肺上叶切除术治疗肺癌的近期临床效果分析. 中国胸心血管外科临床杂志, 2020, 27(2): 183-189.
12. 黄志刚, 吴彦峥, 刘亚锋, 等. 达芬奇机器人辅助胸腔镜肺叶切除术对肺癌患者心肺功能和生存质量的影响分析. 中国医学前沿杂志(电子版), 2020, 12(5): 85-89.
13. 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.
14. Veluswamy RR, Whittaker Brown SA, Mhango G, et al. Comparative effectiveness of robotic-assisted surgery for resectable lung cancer in older patients. Chest, 2020, 157(5): 1313-1321.
15. Zhou Q, Huang J, Pan F, et al. Operative outcomes and long-term survival of robotic-assisted segmentectomy for stage ⅠA lung cancer compared with video-assisted thoracoscopic segmentectomy. Transl Lung Cancer Res, 2020, 9(2): 306-315.
16. Haruki T, Kubouchi Y, Takagi Y, et al. Comparison of medium-term survival outcomes between robot-assisted thoracoscopic surgery and video-assisted thoracoscopic surgery in treating primary lung cancer. Gen Thorac Cardiovasc Surg, 2020, 68(9): 984-992.
17. Zhang Y, Chen C, Hu J, et al. Early outcomes of robotic versus thoracoscopic segmentectomy for early-stage lung cancer: A multi-institutional propensity score-matched analysis. J Thorac Cardiovasc Surg, 2020, 160(5): 1363-1372.
18. Qiu T, Zhao Y, Xuan Y, et al. Robotic sleeve lobectomy for centrally located non-small cell lung cancer: A propensity score-weighted comparison with thoracoscopic and open surgery. J Thorac Cardiovasc Surg, 2020, 160(3): 838-846.
19. Kneuertz PJ, D'Souza DM, Richardson M, et al. Long-term oncologic outcomes after robotic lobectomy for early-stage non-small-cell lung cancer versus video-assisted thoracoscopic and open thoracotomy approach. Clin Lung Cancer, 2020, 21(3): 214-224.
20. Bodner J, Schmid T, Augustin F, et al. Minimally invasive approaches for lung lobectomy—From VATS to robotic and back. Eur Surg, 2011, 43(4): 224-228.
21. Deen SA, Wilson JL, Wilshire CL, et al. Defining the cost of care for lobectomy and segmentectomy: A comparison of open, video-assisted thoracoscopic, and robotic approaches. Ann Thorac Surg, 2014, 97(3): 1000-1007.
22. Demir A, Ayalp K, Ozkan B, et al. Robotic and video-assisted thoracic surgery lung segmentectomy for malignant and benign lesions. Interact Cardiovasc Thorac Surg, 2015, 20(3): 304-309.
23. He Y, Coonar A, Gelvez-Zapata S, et al. Evaluation of a robot-assisted video-assisted thoracoscopic surgery programme. Exp Ther Med, 2014, 7(4): 873-876.
24. Jang HJ, Lee HS, Park SY, et al. Comparison of the early robot-assisted lobectomy experience to video-assisted thoracic surgery lobectomy for lung cancer: A single-institution case series matching study. Innovations (Phila), 2011, 6(5): 305-310.
25. Lee BE, Korst RJ, Kletsman E, et al. Transitioning from video-assisted thoracic surgical lobectomy to robotics for lung cancer: Are there outcomes advantages? J Thorac Cardiovasc Surg, 2014, 147(2): 724-729.
26. Louie BE, Wilson JL, Kim S, et al. Comparison of video-assisted thoracoscopic surgery and robotic approaches for clinical stageⅠ and stageⅡnon-small cell lung cancer using the Society of Thoracic Surgeons Database. Ann Thorac Surg, 2016, 102(3): 917-924.
27. 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.
28. 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.
29. Swanson SJ, Miller DL, McKenna RJ, 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(3): 929-937.
30. Yang CF, Sun Z, Speicher PJ, et al. Use and outcomes of minimally invasive lobectomy for stageⅠ non-small cell lung cancer in the national cancer data base. Ann Thorac Surg, 2016, 101(3): 1037-1042.
31. Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stageⅠnonsmall cell lung cancer: Comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265(2): 431-437.
32. 郭洪拨, 喻本桐. 机器人与胸腔镜肺叶切除术在治疗早期非小细胞肺癌的安全性与疗效对比. 实用医学杂志, 2019, 35(4): 541-545.
33. 何天煜, 王莺, 刘佳聪, 等. VATS与RATS精准解剖的亚肺叶联合切除术的回顾性队列研究. 机器人外科学杂志(中英文), 2022, 3(1): 4-14.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Da-Vinci robot-assisted thoracic surgery versus video-assisted thoracic surgery for non-small cell lung cancer: A systematic review and meta-analysis

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