STS-GTS大数据：临床I/II期非小细胞肺癌达芬奇手术机器人与电视胸腔镜辅助手术比较

Louie BE, Wilson JL, Kim S, Cerfolio RJ, Park BJ, Farivar AS, Vallières E, Aye RW, Burfeind WR Jr, Block MI. 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 Sep;102(3):917-924. doi: 10.1016/j.athoracsur.2016.03.032. Epub 2016 May 19. PMID: 27209613; PMCID: PMC5198574.

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 - PubMed (nih.gov)

Background: Data from selected centers show that robotic lobectomy is safe and effective and has 30-day mortality comparable to that of video-assisted thoracoscopic surgery (VATS). However, widespread adoption of robotic lobectomy is controversial. We used The Society of Thoracic Surgeons General Thoracic Surgery (STS-GTS) Database to evaluate quality metrics for these 2 minimally invasive lobectomy techniques.

Methods: A database query for primary clinical stage I or stage II non-small cell lung cancer (NSCLC) at high-volume centers from 2009 to 2013 identified 1,220 robotic lobectomies and 12,378 VATS procedures. Quality metrics evaluated included operative morbidity, 30-day mortality, and nodal upstaging, defined as cN0 to pN1. Multivariable logistic regression was used to evaluate nodal upstaging.

Results: Patients undergoing robotic lobectomy were older, less active, and less likely to be an ever smoker and had higher body mass index (BMI) (all p < 0.05). They were also more likely to have coronary heart disease or hypertension (all p < 0.001) and to have had preoperative mediastinal staging (p < 0.0001). Robotic lobectomy operative times were longer (median 186 versus 173 minutes; p < 0.001); all other operative measurements were similar. All postoperative outcomes were similar, including complications and 30-day mortality (robotic lobectomy, 0.6% versus VATS, 0.8%; p = 0.4). Median length of stay was 4 days for both, but a higher proportion of patients undergoing robotic lobectomy had hospital stays less than 4 days (48% versus 39%; p < 0.001). Nodal upstaging overall was similar (p = 0.6) but with trends favoring VATS in the cT1b group and robotic lobectomy in the cT2a group.

Conclusions: Patients undergoing robotic lobectomy had more comorbidities and robotic lobectomy operative times were longer, but quality outcome measures, including complications, hospital stay, 30-day mortality, and nodal upstaging, suggest that robotic lobectomy and VATS are equivalent.

讨论 ：DR JOHN A. HOWINGTON (Evanston, IL): Great presentation.Again, I applaud you for doing the study and then also for the message; that it makes intuitive sense that it’s the minimally invasive approach that’s the benefit, not what tools you’re using to accomplish the minimally invasive approach. And I’m happy your data has borne that out, and we can stop the debate. Whatever mode you use to do a minimally invasive operation benefits the patient.
DR LOWELL: I completely agree, and I think that a minimally invasive lobectomy carries all the obvious advantages, and I’m a supporter of implementing them. I just don’t think that making the overall operation more complicated and more expensive is going to be the future.