Perioperative outcomes of robot-assisted versus video-assisted right upper lobectomy in non-small cell lung cancer: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TIAN Yu , HUANG Jia , LU Peiji , LI Jiantao , LIN Hao , JIANG Long , CHEN Tianxiang ,  LUO Qingquan

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

Corresponding?author：

LUO Qingquan, Email: luoqingquan@hotmail.com

Keywords：

Da Vinci robot; video-assisted thoracic surgery; right upper lobectomy; non-small cell lung cancer; surgery

DOI：

10.7507/1007-4848.202007083

Video：

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Objective To summarize the perioperative outcome of patients undergoing robot-assisted thoracic surgery (RATS) or four-port single-direction video-assisted thoracic surgery (VATS) right upper lobectomy (RUL), and to discuss the safety and the essentials of the surgery.Methods The clinical data of 579 patients with non-small cell lung cancer (NSCLC) undergoing minimally invasive RUL in Dr. Luo Qingquan’s team of our center from 2015 to 2018 were retrospectively analyzed. There were 246 males and 333 females aged 33-78 years. The 579 patients were divided into a RATS group (n=283) and a VATS group (n=296) according to surgical methods. Baseline characteristics and perioperative outcomes including dissected lymph nodes, postoperative duration of drainage, postoperative hospital stay, postoperative complications and surgery cost were compared between the two groups.Results There was no significant difference in baseline data between the two groups (P>0.05), and no postoperative 30 d mortality or intraoperative blood transfusion was observed. Compared with VATS, RATS had shorter operation time (90.22±12.16 min vs. 92.68±12.26 min, P=0.016), postoperative hospital stay (4.67±1.43 d vs. 5.31±1.59 d, P<0.001) and time of drainage (3.55±1.38 d vs. 4.16±1.58 d, P<0.001). No significant difference was observed between the two groups in the lymph nodes dissection, blood loss volume, conversion rate or complications. The cost of RATS was much higher than that of VATS (93 275.46±13 276.69 yuan vs. 67 082.58±12 978.17 yuan, P<0.001).Conclusion The safety and effectiveness of robot-assisted and video-assisted RUL are satisfactory, and they have similar perioperative outcomes. However, RATS costs relatively shorter operation time and postoperative hospital stay.

Citation： TIAN Yu, HUANG Jia, LU Peiji, LI Jiantao, LIN Hao, JIANG Long, CHEN Tianxiang, LUO Qingquan. Perioperative outcomes of robot-assisted versus video-assisted right upper lobectomy in non-small cell lung cancer: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(10): 1134-1139. doi: 10.7507/1007-4848.202007083 Copy

1.	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin, 2019, 69(1): 7-34.
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.	Mahieu J, Rinieri P, Bubenheim M, <italic>et al</italic>. 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.
4.	Huang J, Li C, Li H, <italic>et al</italic>. 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.
5.	Liang H, Liang W, Zhao L, <italic>et al</italic>. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: A meta-analysis. Ann Surg, 2018, 268(2): 254-259.
6.	劉倫旭, 車國衛, 蒲強, 等. 單向式全胸腔鏡肺葉切除術. 中華胸心血管外科雜志, 2008, 24(3): 156-158.
7.	黃佳, 趙曉菁, 林皓, 等. 單向四孔法全胸腔鏡肺葉切除術治療非小細胞肺癌的臨床研究. 中國胸心血管外科臨床雜志, 2012, 19(2): 125-129.
8.	許世廣, 王述民. 淺談達芬奇機器人手術500例體會. 中國胸心血管外科臨床雜志, 2015, 22(10): 895-900.
9.	高珂, 劉早陽, 吳劍, 等. 單向式全胸腔鏡肺葉切除術治療早期非小細胞肺癌的臨床療效分析. 中國胸心血管外科臨床雜志, 2011, 18(3): 231-235.
10.	Puri V, Patel A, Majumder K, <italic>et al</italic>. Intraoperative conversion from video-assisted thoracoscopic surgery lobectomy to open thoracotomy: a study of causes and implications. J Thorac Cardiovasc Surg, 2015, 149(1): 55-61.
11.	Sezen CB, Bilen S, Kalafat CE, <italic>et al</italic>. Unexpected conversion to thoracotomy during thoracoscopic lobectomy: a single-center analysis. Gen Thorac Cardiovasc Surg, 2019, 67(11): 969-975.
12.	Lee BE, Shapiro M, Rutledge JR, <italic>et al</italic>. Nodal upstaging in robotic and video assisted thoracic surgery lobectomy for clinical N0 lung cancer. Ann Thorac Surg, 2015, 100(1): 229-233.
13.	Li JT, Liu PY, Huang J, <italic>et al</italic>. Perioperative outcomes of radical lobectomies using robotic-assisted thoracoscopic technique vs. video-assisted thoracoscopic technique: retrospective study of 1, 075 consecutive p-stage Ⅰ non-small cell lung cancer cases. J Thorac Dis, 2019, 11(3): 882-891.
14.	Wilson JL, Louie BE, Cerfolio RJ, <italic>et al</italic>. 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.
15.	Kneuertz PJ, Cheufou DH, D'Souza DM, <italic>et al</italic>. 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.
16.	Swanson SJ, Meyers BF, Gunnarsson CL, <italic>et al</italic>. Video-assisted thoracoscopic lobectomy is less costly and morbid than open lobectomy: a retrospective multiinstitutional database analysis. Ann Thorac Surg, 2012, 93(4): 1027-1032.
17.	Swanson SJ, Miller DL, McKenna RJ, <italic>et al</italic>. 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.
18.	Yang HX, Woo KM, Sima CS, <italic>et al</italic>. 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.
19.	Park BJ, Melfi F, Mussi A, <italic>et al</italic>. Robotic lobectomy for non-small cell lung cancer (NSCLC): long-term oncologic results. J Thorac Cardiovasc Surg, 2012, 143(2): 383-389.
20.	Tamura M, Shimizu Y, Hashizume Y. Pain following thoracoscopic surgery: retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery. J Cardiothorac Surg, 2012, 8: 153.

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin, 2019, 69(1): 7-34.
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. Mahieu J, Rinieri P, Bubenheim M, <italic>et al</italic>. 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.
4. Huang J, Li C, Li H, <italic>et al</italic>. 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.
5. Liang H, Liang W, Zhao L, <italic>et al</italic>. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: A meta-analysis. Ann Surg, 2018, 268(2): 254-259.
6. 劉倫旭, 車國衛, 蒲強, 等. 單向式全胸腔鏡肺葉切除術. 中華胸心血管外科雜志, 2008, 24(3): 156-158.
7. 黃佳, 趙曉菁, 林皓, 等. 單向四孔法全胸腔鏡肺葉切除術治療非小細胞肺癌的臨床研究. 中國胸心血管外科臨床雜志, 2012, 19(2): 125-129.
8. 許世廣, 王述民. 淺談達芬奇機器人手術500例體會. 中國胸心血管外科臨床雜志, 2015, 22(10): 895-900.
9. 高珂, 劉早陽, 吳劍, 等. 單向式全胸腔鏡肺葉切除術治療早期非小細胞肺癌的臨床療效分析. 中國胸心血管外科臨床雜志, 2011, 18(3): 231-235.
10. Puri V, Patel A, Majumder K, <italic>et al</italic>. Intraoperative conversion from video-assisted thoracoscopic surgery lobectomy to open thoracotomy: a study of causes and implications. J Thorac Cardiovasc Surg, 2015, 149(1): 55-61.
11. Sezen CB, Bilen S, Kalafat CE, <italic>et al</italic>. Unexpected conversion to thoracotomy during thoracoscopic lobectomy: a single-center analysis. Gen Thorac Cardiovasc Surg, 2019, 67(11): 969-975.
12. Lee BE, Shapiro M, Rutledge JR, <italic>et al</italic>. Nodal upstaging in robotic and video assisted thoracic surgery lobectomy for clinical N0 lung cancer. Ann Thorac Surg, 2015, 100(1): 229-233.
13. Li JT, Liu PY, Huang J, <italic>et al</italic>. Perioperative outcomes of radical lobectomies using robotic-assisted thoracoscopic technique vs. video-assisted thoracoscopic technique: retrospective study of 1, 075 consecutive p-stage Ⅰ non-small cell lung cancer cases. J Thorac Dis, 2019, 11(3): 882-891.
14. Wilson JL, Louie BE, Cerfolio RJ, <italic>et al</italic>. 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.
15. Kneuertz PJ, Cheufou DH, D'Souza DM, <italic>et al</italic>. 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.
16. Swanson SJ, Meyers BF, Gunnarsson CL, <italic>et al</italic>. Video-assisted thoracoscopic lobectomy is less costly and morbid than open lobectomy: a retrospective multiinstitutional database analysis. Ann Thorac Surg, 2012, 93(4): 1027-1032.
17. Swanson SJ, Miller DL, McKenna RJ, <italic>et al</italic>. 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.
18. Yang HX, Woo KM, Sima CS, <italic>et al</italic>. 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.
19. Park BJ, Melfi F, Mussi A, <italic>et al</italic>. Robotic lobectomy for non-small cell lung cancer (NSCLC): long-term oncologic results. J Thorac Cardiovasc Surg, 2012, 143(2): 383-389.
20. Tamura M, Shimizu Y, Hashizume Y. Pain following thoracoscopic surgery: retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery. J Cardiothorac Surg, 2012, 8: 153.

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Perioperative outcomes of robot-assisted versus video-assisted right upper lobectomy in non-small cell lung cancer: A retrospective cohort study

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