Comparison of short-term outcomes between full-port robotic and thoracoscopic mediastinal tumor resection: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Jun , ZHAO Jiaying , XU Ran , LU Tong , ZHANG Pengfei , QU Lidong ,  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：

Robot-assisted thoracic surgery; video-assisted thoracoscopic surgery; mediastinal tumor; propensity score matching

DOI：

10.7507/1007-4848.202112026

Video：

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Objective To analyze and compare the perioperative efficacy difference between full-port Da Vinci robotic surgery and thoracoscopic surgery in patients with mediastinal tumor resection. Methods The data of 232 patients with mediastinal tumors treated by the same operator in the Department of Thoracic Surgery of the Second Affiliated Hospital of Harbin Medical University were included. There were 103 (44.4%) males and 129 (55.6%) females, with an average age of 49.7 years. According to the surgical methods, they were divided into a robot-assisted thoracic surgery (RATS) group (n=113) and a video-assisted thoracoscopic surgery (VATS) group (n=119). After 1 : 1 propensity score matching, 57 patients in the RATS group and 57 patients in the VATS group were obtained. Results The RATS group was better than the VATS group in the visual analogue scale pain score on the first day after the surgery [3.0 (2.0, 4.0) points vs. 4.0 (3.0, 5.0) points], postoperative hospital stay time [4.0 (3.0, 5.5) d vs. 6.0 (5.0, 7.0) d] and postoperative catheterization time [2.0 (2.0, 3.0) d vs. 3.0 (3.0, 4.0) d] (all P<0.05). There was no statistical difference between the two groups in terms of intraoperative blood loss, postoperative complications, postoperative thoracic closed drainage catheter placement rate or postoperative total drainage volume (all P>0.05). The total hospitalization costs [51 271.0 (44 166.0, 57 152.0) yuan vs. 35 814.0 (33 418.0, 39 312.0) yuan], operation costs [37 659.0 (32 217.0, 41 511.0) yuan vs. 19 640.0 (17 008.0, 21 421.0) yuan], anesthesia costs [3 307.0 (2 530.0, 3 823.0) yuan vs. 2 059.0 (1 577.0, 2 887.0) yuan] and drug and examination costs [9 241.0 (7 987.0, 12 332.0) yuan vs. 14 143.0 (11 620.0, 16 750.0) yuan] in the RATS group was higher than those in the VATS group (all P<0.05). Conclusion Robotic surgery and thoracoscopic surgery can be done safely and effectively. Compared with thoracoscopic surgery, robotic surgery has less postoperative pain, shorter tube-carrying time, and less postoperative hospital stay, which can significantly speed up the postoperative recovery of patients. However, the cost of robotic surgery is higher than that of thoracoscopic surgery, which increases the economic burden of patients and is also one of the main reasons for preventing the popularization of robotic surgery.

Citation： WANG Jun, ZHAO Jiaying, XU Ran, LU Tong, ZHANG Pengfei, QU Lidong, ZHANG Linyou. Comparison of short-term outcomes between full-port robotic and thoracoscopic mediastinal tumor resection: A propensity score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(4): 424-429. doi: 10.7507/1007-4848.202112026 Copy

1.	Whitson BA, Andrade RS, Boettcher A, et al. Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2007, 83(6): 1965-1970.
2.	Boffa DJ, Dhamija A, Kosinski AS, et al. Fewer complications result from a video-assisted approach to anatomic resection of clinical stage Ⅰ lung cancer. J Thorac Cardiovasc Surg, 2014, 148(2): 637-643.
3.	Paul S, Sedrakyan A, Chiu YL, et al. Outcomes after lobectomy using thoracoscopy vs. thoracotomy: A comparative effectiveness analysis utilizing the Nationwide Inpatient Sample Database. Eur J Cardiothorac Surg, 2013, 43(4): 813-817.
4.	Rodríguez-Sanjuán JC, Gómez-Ruiz M, Trugeda-Carrera S, et al. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions. World J Gastroenterol, 2016, 22(6): 1975-2004.
5.	Novara G, Catto JW, Wilson T, et al. Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy. Eur Urol, 2015, 67(3): 376-401.
6.	Liu Z, Li X, Tian S, et al. Superiority of robotic surgery for cervical cancer in comparison with traditional approaches: A systematic review and meta-analysis. Int J Surg, 2017, 40: 145-154.
7.	Cerfolio RJ, Bryant AS, Minnich DJ. Operative techniques in robotic thoracic surgery for inferior or posterior mediastinal pathology. J Thorac Cardiovasc Surg, 2012, 143(5): 1138-1143.
8.	Yoshino I, Hashizume M, Shimada M, et al. Thoracoscopic thymomectomy with the Da Vinci computer-enhanced surgical system. J Thorac Cardiovasc Surg, 2001, 122(4): 783-785.
9.	黃佳, 羅清泉, 譚強. 機器人外科手術系統輔助胸腔鏡胸腺瘤切除手術一例. 上海醫學, 2010, 33(11): 1072.
10.	D'Agostino RB. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med, 1998, 17(19): 2265-2281.
11.	Duhamel A, Labreuche J, Gronnier C, et al. Statistical tools for propensity score matching. Ann Surg, 2017, 265(6): E79-E80.
12.	Chiarotto A, Maxwell LJ, Ostelo RW, et al. Measurement properties of visual analogue scale, numeric rating scale, and pain severity subscale of the brief pain inventory in patients with low back pain: A systematic review. J Pain, 2019, 20(3): 245-263.
13.	Ismail M, Swierzy M, Rückert JC. State of the art of robotic thymectomy. World J Surg, 2013, 37(12): 2740-2746.
14.	莊鶴然, 林洋, 楊新平, 等. 達芬奇機器人輔助腹腔鏡手術250例報告. 中國實驗診斷學, 2018, 22(10): 1792-1795.
15.	Bodner J, Wykypiel H, Greiner A, et al. Early experience with robot-assisted surgery for mediastinal masses. Ann Thorac Surg, 2004, 78(1): 259-265.
16.	DeRose JJ, Swistel DG, Safavi A, et al. Mediastinal mass evaluation using advanced robotic techniques. Ann Thorac Surg, 2003, 75(2): 571-573.
17.	柏啟州, 于珺, 茍云久, 等. 達芬奇機器人手術治療縱隔腫瘤的病例對照研究. 中國胸心血管外科臨床雜志, 2018, 25(5): 382-386.
18.	中國醫師協會醫學機器人醫師分會胸外科專業委員會籌備組, 譚群友, 陶紹霖, 等. 機器人輔助縱隔腫瘤手術中國專家共識 (2019版). 中國胸心血管外科臨床雜志, 2020, 27(2): 117-125.
19.	Li H, Li J, Huang J, et al. Robotic-assisted mediastinal surgery: The first Chinese series of 167 consecutive cases. J Thorac Dis, 2018, 10(5): 2876-2880.
20.	曾理平, 王志田, 何哲浩, 等. 達芬奇機器人與胸腔鏡下縱隔腫瘤切除術的回顧性隊列研究. 中國胸心血管外科臨床雜志, 2020, 27(3): 279-283.
21.	蔣彬, 康珀銘, 陶紹霖, 等. 機器人與胸腔鏡手術治療前縱隔腫物的近期療效對比. 第三軍醫大學學報, 2019, 41(16): 1578-1582.
22.	Zirafa CC, Melfi F. Robot-assisted surgery for posterior mediastinal mass. J Thorac Dis, 2017, 9(12): 4929-4931.
23.	Roh CK, Choi S, Seo WJ, et al. Comparison of surgical outcomes between integrated robotic and conventional laparoscopic surgery for distal gastrectomy: A propensity score matching analysis. Sci Rep, 2020, 10(1): 485.
24.	Weng Y, Chen M, Gemenetzis G, et al. Robotic-assisted versus open total pancreatectomy: A propensity score-matched study. Hepatobiliary Surg Nutr, 2020, 9(6): 759-770.
25.	Lin SY, Lin CL, Lin CC, et al. Association between angiotensin receptor blockers and suicide: Nationwide population-based propensity score matching study. J Affect Disord, 2020, 276: 815-821.
26.	Zhao W, Liu C, Li S, et al. Safety and efficacy for robot-assisted versus open pancreaticoduodenectomy and distal pancreatectomy: A systematic review and meta-analysis. Surg Oncol, 2018, 27(3): 468-478.
27.	Cao C, Manganas C, Ang SC, et al. A systematic review and meta-analysis on pulmonary resections by robotic video-assisted thoracic surgery. Ann Cardiothorac Surg, 2012, 1(1): 3-10.
28.	Savitt MA, Gao G, Furnary AP, et al. Application of robotic-assisted techniques to the surgical evaluation and treatment of the anterior mediastinum. Ann Thorac Surg, 2005, 79(2): 450-455.
29.	Melfi F, Fanucchi O, Davini F, et al. Ten-year experience of mediastinal robotic surgery in a single referral centre. Eur J Cardiothorac Surg, 2012, 41(4): 847-851.
30.	何雙雙. 達芬奇機器人輔助前列腺癌手術應用評價. 解放軍醫院管理雜志, 2021, 28(6): 558-560.
31.	查立超, 邱法波, 韓冰, 等. 達芬奇機器人與開腹手術治療原發性腹膜后腫瘤的對比研究. 中華腔鏡外科雜志(電子版), 2018, 11(6): 367-369.

1. Whitson BA, Andrade RS, Boettcher A, et al. Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2007, 83(6): 1965-1970.
2. Boffa DJ, Dhamija A, Kosinski AS, et al. Fewer complications result from a video-assisted approach to anatomic resection of clinical stage Ⅰ lung cancer. J Thorac Cardiovasc Surg, 2014, 148(2): 637-643.
3. Paul S, Sedrakyan A, Chiu YL, et al. Outcomes after lobectomy using thoracoscopy vs. thoracotomy: A comparative effectiveness analysis utilizing the Nationwide Inpatient Sample Database. Eur J Cardiothorac Surg, 2013, 43(4): 813-817.
4. Rodríguez-Sanjuán JC, Gómez-Ruiz M, Trugeda-Carrera S, et al. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions. World J Gastroenterol, 2016, 22(6): 1975-2004.
5. Novara G, Catto JW, Wilson T, et al. Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy. Eur Urol, 2015, 67(3): 376-401.
6. Liu Z, Li X, Tian S, et al. Superiority of robotic surgery for cervical cancer in comparison with traditional approaches: A systematic review and meta-analysis. Int J Surg, 2017, 40: 145-154.
7. Cerfolio RJ, Bryant AS, Minnich DJ. Operative techniques in robotic thoracic surgery for inferior or posterior mediastinal pathology. J Thorac Cardiovasc Surg, 2012, 143(5): 1138-1143.
8. Yoshino I, Hashizume M, Shimada M, et al. Thoracoscopic thymomectomy with the Da Vinci computer-enhanced surgical system. J Thorac Cardiovasc Surg, 2001, 122(4): 783-785.
9. 黃佳, 羅清泉, 譚強. 機器人外科手術系統輔助胸腔鏡胸腺瘤切除手術一例. 上海醫學, 2010, 33(11): 1072.
10. D'Agostino RB. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med, 1998, 17(19): 2265-2281.
11. Duhamel A, Labreuche J, Gronnier C, et al. Statistical tools for propensity score matching. Ann Surg, 2017, 265(6): E79-E80.
12. Chiarotto A, Maxwell LJ, Ostelo RW, et al. Measurement properties of visual analogue scale, numeric rating scale, and pain severity subscale of the brief pain inventory in patients with low back pain: A systematic review. J Pain, 2019, 20(3): 245-263.
13. Ismail M, Swierzy M, Rückert JC. State of the art of robotic thymectomy. World J Surg, 2013, 37(12): 2740-2746.
14. 莊鶴然, 林洋, 楊新平, 等. 達芬奇機器人輔助腹腔鏡手術250例報告. 中國實驗診斷學, 2018, 22(10): 1792-1795.
15. Bodner J, Wykypiel H, Greiner A, et al. Early experience with robot-assisted surgery for mediastinal masses. Ann Thorac Surg, 2004, 78(1): 259-265.
16. DeRose JJ, Swistel DG, Safavi A, et al. Mediastinal mass evaluation using advanced robotic techniques. Ann Thorac Surg, 2003, 75(2): 571-573.
17. 柏啟州, 于珺, 茍云久, 等. 達芬奇機器人手術治療縱隔腫瘤的病例對照研究. 中國胸心血管外科臨床雜志, 2018, 25(5): 382-386.
18. 中國醫師協會醫學機器人醫師分會胸外科專業委員會籌備組, 譚群友, 陶紹霖, 等. 機器人輔助縱隔腫瘤手術中國專家共識 (2019版). 中國胸心血管外科臨床雜志, 2020, 27(2): 117-125.
19. Li H, Li J, Huang J, et al. Robotic-assisted mediastinal surgery: The first Chinese series of 167 consecutive cases. J Thorac Dis, 2018, 10(5): 2876-2880.
20. 曾理平, 王志田, 何哲浩, 等. 達芬奇機器人與胸腔鏡下縱隔腫瘤切除術的回顧性隊列研究. 中國胸心血管外科臨床雜志, 2020, 27(3): 279-283.
21. 蔣彬, 康珀銘, 陶紹霖, 等. 機器人與胸腔鏡手術治療前縱隔腫物的近期療效對比. 第三軍醫大學學報, 2019, 41(16): 1578-1582.
22. Zirafa CC, Melfi F. Robot-assisted surgery for posterior mediastinal mass. J Thorac Dis, 2017, 9(12): 4929-4931.
23. Roh CK, Choi S, Seo WJ, et al. Comparison of surgical outcomes between integrated robotic and conventional laparoscopic surgery for distal gastrectomy: A propensity score matching analysis. Sci Rep, 2020, 10(1): 485.
24. Weng Y, Chen M, Gemenetzis G, et al. Robotic-assisted versus open total pancreatectomy: A propensity score-matched study. Hepatobiliary Surg Nutr, 2020, 9(6): 759-770.
25. Lin SY, Lin CL, Lin CC, et al. Association between angiotensin receptor blockers and suicide: Nationwide population-based propensity score matching study. J Affect Disord, 2020, 276: 815-821.
26. Zhao W, Liu C, Li S, et al. Safety and efficacy for robot-assisted versus open pancreaticoduodenectomy and distal pancreatectomy: A systematic review and meta-analysis. Surg Oncol, 2018, 27(3): 468-478.
27. Cao C, Manganas C, Ang SC, et al. A systematic review and meta-analysis on pulmonary resections by robotic video-assisted thoracic surgery. Ann Cardiothorac Surg, 2012, 1(1): 3-10.
28. Savitt MA, Gao G, Furnary AP, et al. Application of robotic-assisted techniques to the surgical evaluation and treatment of the anterior mediastinum. Ann Thorac Surg, 2005, 79(2): 450-455.
29. Melfi F, Fanucchi O, Davini F, et al. Ten-year experience of mediastinal robotic surgery in a single referral centre. Eur J Cardiothorac Surg, 2012, 41(4): 847-851.
30. 何雙雙. 達芬奇機器人輔助前列腺癌手術應用評價. 解放軍醫院管理雜志, 2021, 28(6): 558-560.
31. 查立超, 邱法波, 韓冰, 等. 達芬奇機器人與開腹手術治療原發性腹膜后腫瘤的對比研究. 中華腔鏡外科雜志(電子版), 2018, 11(6): 367-369.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison of short-term outcomes between full-port robotic and thoracoscopic mediastinal tumor resection: A propensity score matching study

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