The effectiveness and safety of Da Vinci robotic-assisted thoracic surgery versus video assisted thoracic surgery for non-small cell lung cancer: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 GOU Yunjiu ^1,2# , MA Jilong ^1,2,3,4,5# , YAO Liang ² , HE Shengliang ¹ , WANG Chengfeng ¹ , JIN Penghui ^2,3 , BAI Qizhou ¹ , YU Jun ¹ ,  YANG Kehu ^2,4,5

1. Department of Thoracic Surgery, The Gansu Provincial Hospital, Lanzhou, 730000, P.R.China;
2. Institution of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Lanzhou, 730000, P.R.China;
3. Gansu University of Chinese Medicine, Lanzhou, 730000, P.R.China;
4. Evidence Based Medicine Center, Lanzhou University, Lanzhou, 730000, P.R.China;
5. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, P.R.China;

Corresponding author：

GOU Yunjiu, Email: gouyunjiu@163.com; YANG Kehu, Email: kehuyangebm2006@126.com

Keywords：

Da Vinci robot assisted thoracic surgery; Lung cancer; Video assisted thoracic surgery; Meta-analysis; Case-control study; Systematic review

DOI：

10.7507/1672-2531.201612069

Video：

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ObjectiveTo systematically review the efficacy and safety of robotic-assisted thoracic surgery (RATS) and video assisted thoracic surgery (VATS) for patients with non-small cell lung cancer (NSCLC). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 9, 2016), Web of Science, CNKI, VIP, WanFang Data and CBM databases to collect clinical studies about RATS vs. VATS for patients with NSCLC from inception to October 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 14 cohort studies involving 19 921 patients were included; among them, 4 322 cases were in the RATS group, and 15 599 were in the VATS group. The results of meta-analysis showed that the operation time (MD=22.90, 95%CI 9.97 to 35.84, P<0.000 5) was longer in the RATS group than the VATS group. However, the conversion rate (OR=0.72, 95%CI 0.44 to 1.18, P=0.20), the incidence of postoperative complications (OR=1.06, 95%CI 0.96 to 1.17, P=0.28), intraoperative blood loss (MD=2.75, 95%CI –8.39 to 13.89, P=0.63), postoperative hospitalization time (MD=–0.00, 95%CI –0.02 to 0.02, P=0.99) and in-hospital mortality rate (OR=0.60, 95%CI 0.35 to 1.05, P=0.07) were not significant differences between both groups.ConclusionThe current meta-analysis indicates that the efficacy and safety of RATS and VATS for NSCLC is equivalence, however the operation time for RATS is longer. Due to the limited quantity and quality of inclued studies, the above conclusions still need to be verified by more high quality studies.

Citation： GOU Yunjiu, MA Jilong, YAO Liang, HE Shengliang, WANG Chengfeng, JIN Penghui, BAI Qizhou, YU Jun, YANG Kehu. The effectiveness and safety of Da Vinci robotic-assisted thoracic surgery versus video assisted thoracic surgery for non-small cell lung cancer: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(6): 661-668. doi: 10.7507/1672-2531.201612069 Copy

1.	Khazaei S, Salehiniya H, Mohammadian-Hafshejani A, et al. Some facts about cancer in the world using registered cancer in 2012. Iran J Public Health, 2015, 44(11): 1559-1560.
2.	Kirby TJ, Rice TW.Thoracoscopic Lobectomy. Ann Thorac Surg, 1993, 56(3): 784-786.
3.	Walker WS, Carnochan FM, Pugh GC, et al. Thoracoscopic pulmonary lobectomy. Early operative experience and preliminary clinical results. J Thorac Cardiovasc Surg, 1993, 106(6): 1111-1117.
4.	Cao C, Melfi f, Yan T, et al.Minimally invasive thoracic surgery in the 21st century: rise of the robots?Ann Thorac Surg, 2014, 98(6): 2272.
5.	Nakamura H, Taniguchi Y. Robot-assisted thoracoscopic surgery for ung cancer. Kyobu Geka, 2016, 69(8): 650-654.
6.	Nakamura H, Taniguchi Y. Robot-assisted thoracoscopic surgery: current status and prospects. Gen Thorac Cardiovasc Surg, 2013, 61(3): 127-132.
7.	Hozo SP, Djulbegovic B, Hozo I, et al. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 2005, 5: 13.
8.	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.
9.	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.
10.	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.
11.	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.
12.	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.
13.	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.
14.	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.
15.	Louie BE, Wilson JL, Kim S, et al.Comparison of video-assisted thoracoscopic surgery and robotic approaches for clinical stage I and stage II non-small cell lung cancer using the society of thoracic surgeons database. Ann Thorac Surg, 2016, 102(3): 917-924.
16.	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.
17.	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.
18.	Swanson SJ, Miller DL, McKenna RJ Jr, 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.
19.	Yang CJ, Sun Z, Speicher PJ, et al.Use and outcomes of minimally invasive lobectomy for stage I non-small cell lung cancer in the national cancer data base. Ann Thorac Surg, 2016, 101(3): 1037-1042.
20.	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.
21.	Takagi H, Yamamoto H, Goto SN, et al. Perioperative results of robotic lung lobectomy: summary of literature. Surg Endosc, 2012, 26(4): 1190-1191.
22.	Wei B, Eldaif SM, Cerfolio RJ, et al.Robotic lung resection for non-small cell lung cancer. Surg Oncol Clin N Am, 2016, 25(3): 515-531.
23.	Dewey TM, Mack MJ.Lung cancer. Surgical approaches and incisions. Chest Surg Clin N Am, 2000, 10(4): 803-820.
24.	Rinieri P, Peillon C, Salaün M, et al.Perioperative outcomes of video-and robot-assisted segmentectomies. Asian Cardiovasc Thorac Ann, 2016, 24(2): 145-151.
25.	Balduyck B, Hendriks JM, Lauwers P, et al.Quality of life after anterior mediastinal mass resection: a prospective study comparing open with robotic-assisted thoracoscopic resection. Eur J Cardiothorac Surg, 2011, 39(4): 543-548.
26.	Oh DS, Cho I, Karamian B, et al.Early adoption of robotic pulmonary lobectomy: feasibility and initial outcome. Am Surg, 2013, 79(10): 1075-1080.
27.	Diego Gonzalez-Rivas. Evolving thoracic surgery: from open surgery to single port thoracoscopic surgery and future robotic.Chin J Cancer Res, 2013, 25(1): 4-6.
28.	Razvi K, Chua S, Arulkumaran S, et al.A comparison between visual estimation and laboratory determination of blood loss during the third stage of labour. Aust N Z J Obstet Gynaecol, 1996, 36(2): 152-154.

1. Khazaei S, Salehiniya H, Mohammadian-Hafshejani A, et al. Some facts about cancer in the world using registered cancer in 2012. Iran J Public Health, 2015, 44(11): 1559-1560.
2. Kirby TJ, Rice TW.Thoracoscopic Lobectomy. Ann Thorac Surg, 1993, 56(3): 784-786.
3. Walker WS, Carnochan FM, Pugh GC, et al. Thoracoscopic pulmonary lobectomy. Early operative experience and preliminary clinical results. J Thorac Cardiovasc Surg, 1993, 106(6): 1111-1117.
4. Cao C, Melfi f, Yan T, et al.Minimally invasive thoracic surgery in the 21st century: rise of the robots?Ann Thorac Surg, 2014, 98(6): 2272.
5. Nakamura H, Taniguchi Y. Robot-assisted thoracoscopic surgery for ung cancer. Kyobu Geka, 2016, 69(8): 650-654.
6. Nakamura H, Taniguchi Y. Robot-assisted thoracoscopic surgery: current status and prospects. Gen Thorac Cardiovasc Surg, 2013, 61(3): 127-132.
7. Hozo SP, Djulbegovic B, Hozo I, et al. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 2005, 5: 13.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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.
13. 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.
14. 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.
15. Louie BE, Wilson JL, Kim S, et al.Comparison of video-assisted thoracoscopic surgery and robotic approaches for clinical stage I and stage II non-small cell lung cancer using the society of thoracic surgeons database. Ann Thorac Surg, 2016, 102(3): 917-924.
16. 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.
17. 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.
18. Swanson SJ, Miller DL, McKenna RJ Jr, 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.
19. Yang CJ, Sun Z, Speicher PJ, et al.Use and outcomes of minimally invasive lobectomy for stage I non-small cell lung cancer in the national cancer data base. Ann Thorac Surg, 2016, 101(3): 1037-1042.
20. 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.
21. Takagi H, Yamamoto H, Goto SN, et al. Perioperative results of robotic lung lobectomy: summary of literature. Surg Endosc, 2012, 26(4): 1190-1191.
22. Wei B, Eldaif SM, Cerfolio RJ, et al.Robotic lung resection for non-small cell lung cancer. Surg Oncol Clin N Am, 2016, 25(3): 515-531.
23. Dewey TM, Mack MJ.Lung cancer. Surgical approaches and incisions. Chest Surg Clin N Am, 2000, 10(4): 803-820.
24. Rinieri P, Peillon C, Salaün M, et al.Perioperative outcomes of video-and robot-assisted segmentectomies. Asian Cardiovasc Thorac Ann, 2016, 24(2): 145-151.
25. Balduyck B, Hendriks JM, Lauwers P, et al.Quality of life after anterior mediastinal mass resection: a prospective study comparing open with robotic-assisted thoracoscopic resection. Eur J Cardiothorac Surg, 2011, 39(4): 543-548.
26. Oh DS, Cho I, Karamian B, et al.Early adoption of robotic pulmonary lobectomy: feasibility and initial outcome. Am Surg, 2013, 79(10): 1075-1080.
27. Diego Gonzalez-Rivas. Evolving thoracic surgery: from open surgery to single port thoracoscopic surgery and future robotic.Chin J Cancer Res, 2013, 25(1): 4-6.
28. Razvi K, Chua S, Arulkumaran S, et al.A comparison between visual estimation and laboratory determination of blood loss during the third stage of labour. Aust N Z J Obstet Gynaecol, 1996, 36(2): 152-154.

Chinese Journal of Evidence-Based Medicine

The effectiveness and safety of Da Vinci robotic-assisted thoracic surgery versus video assisted thoracic surgery for non-small cell lung cancer: a meta-analysis

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