The clinical efficacy of all-port robotic versus thoracoscopic lobectomy in stageⅠA non-small cell lung cancer: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YAO Lingqi , CHANG Xiaoyan , SHEN Zhiping , WANG Kaiyu , LI Yi , XU Hao ,  ZHANG Linyou

Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, P. R. China;

Corresponding author：

ZHANG Linyou, Email: lyzhang@hrbmu.edu.cn

Keywords：

StageⅠA non-small cell lung cancer; robot-assisted thoracic surgery; video-assisted thoracoscopic surgery; lobectomy; lymph node dissection

DOI：

10.7507/1007-4848.202303029

Video：

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Objective To investigate the perioperative efficacy and safety of all-port robotic lobectomy versus thoracoscopic lobectomy in stageⅠA non-small cell lung cancer. Methods The clinical data of patients with stageⅠA non-small cell lung cancer who underwent lobectomy with lymph node dissection performed by the same operator in our center from June 2019 to June 2022 were retrospectively analyzed. The patients were divided into a robotic group and a thoracoscopic group according to different procedures. We compared the relevant indexes such as operation time, intraoperative bleeding, number of lymph node dissection stations, number of lymph node dissection, postoperative tube time, postoperative hospitalization time, closed chest drainage volume, postoperative pain, postoperative complications and hospitalization cost between the two groups. Results There were 83 patients in the robotic group, including 34 males and 49 females with a median age of 60.0 (53.0, 67.0) years, and 94 patients in the thoracoscopic group, including 36 males and 58 females with a median age of 60.5 (54.0, 65.3) years. There was no conversion to thoractomy or death in postoperative 90 days in both groups. No statistical difference was seen in the operation time, total postoperative drainage volume and postoperative complication rates between the two groups (P>0.05). Patients in the robotic group had less intraoperative bleeding (P<0.001), more lymph node dissection stations (P=0.002) and numbers (P=0.005), less postoperative pain (P=0.002), and shorter postoperative time with tubes (P=0.031) and hospital stay (P<0.001). However, the surgery was more expensive in the robotic group (P<0.001). Conclusion All-port robotic surgery is safe and effective for patients with early-stage non-small cell lung cancer with less intraoperative bleeding, more lymph node dissection, less postoperative pain, and shorter hospital stay compared with the thoracoscopic surgery.

Citation： YAO Lingqi, CHANG Xiaoyan, SHEN Zhiping, WANG Kaiyu, LI Yi, XU Hao, ZHANG Linyou. The clinical efficacy of all-port robotic versus thoracoscopic lobectomy in stageⅠA non-small cell lung cancer: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1390-1395. doi: 10.7507/1007-4848.202303029 Copy

1.	Fan Y, Jiang Y, Li X, et al. Burden of lung cancer attributable to occupational carcinogens from 1990 to 2019 and projections until 2044 in China. Cancers (Basel), 2022, 14(16): 3883.
2.	Chen P, Liu Y, Wen Y, et al. Non-small cell lung cancer in China. Cancer Commun (Lond), 2022, 42(10): 937-970.
3.	Hoy H, Lynch T, Beck M. Surgical treatment of lung cancer. Crit Care Nurs Clin North Am, 2019, 31(3): 303-313.
4.	Gaudet MA, D'Amico TA. Thoracoscopic lobectomy for non-small cell lung cancer. Surg Oncol Clin N Am, 2016, 25(3): 503-513.
5.	Sihoe ADL. Video-assisted thoracoscopic surgery as the gold standard for lung cancer surgery. Respirology, 2020, 25 Suppl 2: 49-60.
6.	郑慧禹, 邵志鹏, 赵冬峰, 等. 胸腔镜微创手术与传统开胸手术治疗非小细胞肺癌患者的临床疗效比较. 癌症进展, 2021, 19(5): 499-502, 506.
7.	Cerfolio RJ, Ghanim AF, Dylewski M, et al. The long-term survival of robotic lobectomy for non-small cell lung cancer: A multi-institutional study. J Thorac Cardiovasc Surg, 2018, 155(2): 778-786.
8.	Dai F, Xu S, Xu W, et al. A paired case controlled study comparing the short-term outcomes of Da Vinci RATS and VATS approach for non-small cell lung cancer. Zhongguo Fei Ai Za Zhi, 2018, 21(3): 206-211.
9.	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.
10.	Ramadan OI, Wei B, Cerfolio RJ. Robotic surgery for lung resections-total port approach: Advantages and disadvantages. J Vis Surg, 2017, 3: 22.
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12.	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.
13.	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.
14.	张连民, 赵晓亮, 徐峰, 等. 全孔道(port-only)人工气胸下机器人辅助肺叶切除术. 中国肺癌杂志, 2020, 23(1): 50-54.
15.	赵金龙, 田辉, 张凤伟. 早期非小细胞肺癌淋巴结转移的危险因素研究. 中国临床医生杂志, 2023, 51(1): 20-23.
16.	王楠, 姜京京, 梁珊珊, 等. 非小细胞肺癌患者微创切除术后复发与转移的相关因素分析. 实用癌症杂志, 2022, 37(10): 1635-1638.
17.	Nelson DB, Mehran RJ, Mitchell KG, et al. Robotic-assisted lobectomy for non-small cell lung cancer: A comprehensive institutional experience. Ann Thorac Surg, 2019, 108(2): 370-376.
18.	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.
19.	Shindo Y, Miyajima M, Nakamura Y, et al. Number of lymph nodes dissected and upstaging rate of the N factor in robot-assisted thoracic surgery versus video-assisted thoracic surgery for patients with cN0 primary lung cancer. Surg Today, 2023, 53(4): 428-434.
20.	Kozower BD, Sheng S, O'Brien SM, et al. STS database risk models: Predictors of mortality and major morbidity for lung cancer resection. Ann Thorac Surg, 2010, 90(3): 875-881.
21.	林俊峰, 蔡东妙, 耿国军. Ⅰ、Ⅱ期非小细胞肺癌患者胸腔镜术后并发症发生的影响因素. 中外医学研究, 2022, 20(21): 39-43.
22.	Stamenovic D, Messerschmidt A, Steger V, et al. New method in treatment of post-operative air leakage with fresh frozen plasma. ANZ J Surg, 2020, 90(1-2): 144-149.
23.	李华胜, 梅建东, 赵珂嘉. 肺手术后持续性漏气的现状及相关进展. 中国胸心血管外科临床杂志, 2016, 23(8): 832-836.
24.	Terra RM, Leite PHC, Dela Vega AJM. Global status of the robotic thoracic surgery. J Thorac Dis, 2021, 13(10): 6123-6128.
25.	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.
26.	Shanahan B, Kreaden US, Sorensen J, et al. Is robotic lobectomy cheaper? A micro-cost analysis. J Robot Surg, 2022, 16(6): 1441-1450.

1. Fan Y, Jiang Y, Li X, et al. Burden of lung cancer attributable to occupational carcinogens from 1990 to 2019 and projections until 2044 in China. Cancers (Basel), 2022, 14(16): 3883.
2. Chen P, Liu Y, Wen Y, et al. Non-small cell lung cancer in China. Cancer Commun (Lond), 2022, 42(10): 937-970.
3. Hoy H, Lynch T, Beck M. Surgical treatment of lung cancer. Crit Care Nurs Clin North Am, 2019, 31(3): 303-313.
4. Gaudet MA, D'Amico TA. Thoracoscopic lobectomy for non-small cell lung cancer. Surg Oncol Clin N Am, 2016, 25(3): 503-513.
5. Sihoe ADL. Video-assisted thoracoscopic surgery as the gold standard for lung cancer surgery. Respirology, 2020, 25 Suppl 2: 49-60.
6. 郑慧禹, 邵志鹏, 赵冬峰, 等. 胸腔镜微创手术与传统开胸手术治疗非小细胞肺癌患者的临床疗效比较. 癌症进展, 2021, 19(5): 499-502, 506.
7. Cerfolio RJ, Ghanim AF, Dylewski M, et al. The long-term survival of robotic lobectomy for non-small cell lung cancer: A multi-institutional study. J Thorac Cardiovasc Surg, 2018, 155(2): 778-786.
8. Dai F, Xu S, Xu W, et al. A paired case controlled study comparing the short-term outcomes of Da Vinci RATS and VATS approach for non-small cell lung cancer. Zhongguo Fei Ai Za Zhi, 2018, 21(3): 206-211.
9. 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.
10. Ramadan OI, Wei B, Cerfolio RJ. Robotic surgery for lung resections-total port approach: Advantages and disadvantages. J Vis Surg, 2017, 3: 22.
11. Soliman BG, Nguyen DT, Chan EY, et al. Impact of da Vinci Xi robot in pulmonary resection. J Thorac Dis, 2020, 12(7): 3561-3572.
12. 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.
13. 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.
14. 张连民, 赵晓亮, 徐峰, 等. 全孔道(port-only)人工气胸下机器人辅助肺叶切除术. 中国肺癌杂志, 2020, 23(1): 50-54.
15. 赵金龙, 田辉, 张凤伟. 早期非小细胞肺癌淋巴结转移的危险因素研究. 中国临床医生杂志, 2023, 51(1): 20-23.
16. 王楠, 姜京京, 梁珊珊, 等. 非小细胞肺癌患者微创切除术后复发与转移的相关因素分析. 实用癌症杂志, 2022, 37(10): 1635-1638.
17. Nelson DB, Mehran RJ, Mitchell KG, et al. Robotic-assisted lobectomy for non-small cell lung cancer: A comprehensive institutional experience. Ann Thorac Surg, 2019, 108(2): 370-376.
18. 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.
19. Shindo Y, Miyajima M, Nakamura Y, et al. Number of lymph nodes dissected and upstaging rate of the N factor in robot-assisted thoracic surgery versus video-assisted thoracic surgery for patients with cN0 primary lung cancer. Surg Today, 2023, 53(4): 428-434.
20. Kozower BD, Sheng S, O'Brien SM, et al. STS database risk models: Predictors of mortality and major morbidity for lung cancer resection. Ann Thorac Surg, 2010, 90(3): 875-881.
21. 林俊峰, 蔡东妙, 耿国军. Ⅰ、Ⅱ期非小细胞肺癌患者胸腔镜术后并发症发生的影响因素. 中外医学研究, 2022, 20(21): 39-43.
22. Stamenovic D, Messerschmidt A, Steger V, et al. New method in treatment of post-operative air leakage with fresh frozen plasma. ANZ J Surg, 2020, 90(1-2): 144-149.
23. 李华胜, 梅建东, 赵珂嘉. 肺手术后持续性漏气的现状及相关进展. 中国胸心血管外科临床杂志, 2016, 23(8): 832-836.
24. Terra RM, Leite PHC, Dela Vega AJM. Global status of the robotic thoracic surgery. J Thorac Dis, 2021, 13(10): 6123-6128.
25. 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.
26. Shanahan B, Kreaden US, Sorensen J, et al. Is robotic lobectomy cheaper? A micro-cost analysis. J Robot Surg, 2022, 16(6): 1441-1450.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The clinical efficacy of all-port robotic versus thoracoscopic lobectomy in stageⅠA non-small cell lung cancer: A retrospective cohort study

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