The efficacy of da Vinci robot-assisted lobectomy versus segmentectomy for stage ⅠA non-small cell lung cancer: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Yuchi ^1,2 , XU Shiguang ² , XU Wei ² , MENG Hao ² , WANG Xilong ² , DING Renquan ² , WANG Shiqi ² , LIU Bo ² , LIU Dazhi ² , TENG Hong ² ,  WANG Shumin ²

1. Postgraduate Training Base of General Hospital of the Northern Theater Command, China Medical University, Shenyang, 110016, P. R. China;
2. Department of Thoracic Surgery, General Hospital of the Northern Theater Command, Shenyang, 110016, P. R. China;

Corresponding?author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Da Vinci robot; stage ⅠA non-small cell lung cancer; segmentectomy; lobectomy; prognosis

DOI：

10.7507/1007-4848.202206059

Video：

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Objective To compare and analyze the therapeutic effects of robot-assisted lobectomy and segmentectomy for stage ⅠA non-small cell lung cancer with a diameter≤2 cm. Methods A total of 181 patients with pathologically confirmed stage ⅠA non-small cell lung cancer (diameter≤2 cm) who underwent robot-assisted lobectomy and segmentectomy in our hospital from 2018 to 2021 were included. There were 74 males and 107 females with an average age of 57.50±10.60 years. They were divided into two groups according to the surgical procedure: a segmentectomy group (85 patients) and a lobectomy group (96 patients). Results There was no statistically significant difference between the two groups in terms of clinical data such as age, gender, smoking history, basic disease, pathological type, tumour diameter, operative time, postoperative 24 h drainage volume and overall complications (P>0.05). The intraoperative blood loss (33.88±16.26 mL vs. 39.27±19.48 mL, P=0.046), groups of dissected lymph nodes (4.76±1.19 vs. 5.52±1.46, P=0.000), number of dissected lymph nodes (14.81±7.23 vs. 18.06±7.70, P=0.004) and postoperative 72 h drainage volume (561.65±225.31 mL vs. 649.84±324.34 mL, P=0.037) of patients in the segmentectomy were less than those in the lobectomy group. The chest drainage time (5.49±3.92 d vs. 7.60±4.96 d, P=0.002) and postoperative hospital stay time (7.47±4.16 d vs. 9.67±5.50 d, P=0.003) were shorter than those in the lobectomy group. There was no conversion to thoracotomy or perioperative death in the two groups. The postoperative follow-up rate was 100.0% with a longest follow-up time of 48 months. The 3-year recurrence-free survival rates of the segmentectomy group and lobectomy group were 87.7% and 92.4%, respectively (P=0.465). Conclusion The da Vinci robot-assisted lobectomy and segmentectomy are safe and feasible surgical procedures for patients with stage ⅠA non-small cell lung cancer (diameter≤2 cm), with a similar 3-year recurrence-free survival rate. The lobectomy group has more lymph nodes dissected, while the segmentectomy group is superior to the lobectomy group in terms of intraoperative blood loss, postoperative 72 h chest drainage volume, chest drainage time and postoperative hospitalization time.

Citation： WU Yuchi, XU Shiguang, XU Wei, MENG Hao, WANG Xilong, DING Renquan, WANG Shiqi, LIU Bo, LIU Dazhi, TENG Hong, WANG Shumin. The efficacy of da Vinci robot-assisted lobectomy versus segmentectomy for stage ⅠA non-small cell lung cancer: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(1): 58-64. doi: 10.7507/1007-4848.202206059 Copy

1.	Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: A secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
2.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
3.	Lancaster HL, Heuvelmans MA, Oudkerk M. Low-dose computed tomography lung cancer screening: Clinical evidence and implementation research. J Intern Med, 2022, 292(1): 68-80.
4.	Duma N, Santana-Davila R, Molina JR. Non-small cell lung cancer: Epidemiology, screening, diagnosis, and treatment. Mayo Clin Proc, 2019, 94(8): 1623-1640.
5.	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.
6.	周研, 張建平, 耿仲偉, 等. 解剖性肺段切除術與肺葉切除術治療磨玻璃結節樣非小細胞肺癌的療效分析. 局解手術學雜志, 2022, 31(3): 198-201.
7.	Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
8.	湯井雙, 黃晶晶, 李志華, 等. 肺葉切除術與肺段切除術治療直徑≤2 cm浸潤性肺腺癌的臨床效果分析. 南京醫科大學學報(自然科學版), 2022, 42(3): 387-392.
9.	Bennett WF, Smith RA. Segmental resection for bronchogenic carcinoma: A surgical alternative for the compromised patient. Ann Thorac Surg, 1979, 27(2): 169-172.
10.	Miller JI, Hatcher CR. Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function. Ann Thorac Surg, 1987, 44(4): 340-343.
11.	王俊, 趙輝. 亞肺葉切除治療早期肺癌需要考慮的幾個問題. 中國肺癌雜志, 2016, 19(6): 351-354.
12.	Kirby TJ, Mack MJ, Landreneau RJ, et al. Initial experience with video-assisted thoracoscopic lobectomy. Ann Thorac Surg, 1993, 56(6): 1248-1252.
13.	Walker WS, Carnochan FM, Pugh GC. Thoracoscopic pulmonary lobectomy. Early operative experience and preliminary clinical results. J Thorac Cardiovasc Surg, 1993, 106: 1111-1117.
14.	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.
15.	郭洪撥, 喻本桐. 機器人與胸腔鏡肺葉切除術在治療早期非小細胞肺癌的安全性與療效對比. 實用醫學雜志, 2019, 35(4): 541-545.
16.	柴新春, 許世廣, 劉博, 等. ⅠA期非小細胞肺癌行達芬奇機器人和電視胸腔鏡肺段切除術近期療效對比分析. 中華胸心血管外科雜志, 2021, 37(11): 644-648.
17.	齊凱, 曾惟標, 魏益平, 等. 胸腔鏡下肺段切除術與肺葉切除術治療Ⅰ期非小細胞肺癌遠期療效的Meta分析. 實用臨床醫學, 2021, 22(5): 18-23, 30.
18.	黃文海, 林志潮, 謝澤華, 等. 胸腔鏡肺葉切除術與肺段切除術治療早期肺癌的療效差異研究. 中國現代醫生, 2021, 59(16): 72-74, 78.
19.	燕曉光, 張軍, 羅衛民, 等. 微創肺葉切除術與微創肺段切除術治療早期非小細胞肺癌的臨床療效比較. 中國醫學工程, 2022, 30(7): 69-73.
20.	納迪爾·伊敏, 陸周一, 白赟彪, 等. 基于傾向性評分匹配法探討胸腔鏡下解剖性肺段切除與肺葉切除對術后患者肺功能影響. 中華胸心血管外科雜志, 2022, 38(1): 1-4.
21.	李小軍, 張璞, 薛鋒. 胸腔鏡微創外科與傳統手術治療原發性縱隔腫瘤的臨床療效及安全性比較. 貴州醫藥, 2021, 45(3): 372-373.
22.	Melfi FM, Menconi GF, Mariani AM, et al. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg, 2002, 21(5): 864-868.
23.	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, 2016, 64(4): 354-362.
24.	Wei S, Chen M, Chen N, et al. Feasibility and safety of robot-assisted thoracic surgery for lung lobectomy in patients with non-small cell lung cancer: A systematic review and meta-analysis. World J Surg Oncol, 2017, 15(1): 98.
25.	許世廣, 劉星池, 王希龍, 等. 應用達芬奇機器人手術系統肺切除技術總結. 中華胸部外科電子雜志, 2016, 3(2): 77-82.
26.	王述民. 機器人手術十年體會. 中華胸部外科電子雜志, 2021, 8(1): 1-5.
27.	Nomori H, Yamazaki I, Machida Y, et al. Lobectomy versus segmentectomy: A propensity score-matched comparison of postoperative complications, pulmonary function and prognosis. Interact Cardiovasc Thorac Surg, 2022, 34(1): 57-65.
28.	Carr SR, Schuchert MJ, Pennathur A, et al. Impact of tumor size on outcomes after anatomic lung resection for stage ⅠA non-small cell lung cancer based on the current staging system. J Thorac Cardiovasc Surg, 2012, 143(2): 390-397.
29.	Moon MH, Moon YK, Moon SW. Segmentectomy versus lobectomy in early non-small cell lung cancer of 2 cm or less in size: A population-based study. Respirology, 2018, 23(7): 695-703.
30.	Tsutani Y, Miyata Y, Nakayama H, et al. Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage ⅠA lung adenocarcinoma: Propensity score-matched analysis in a multicenter study. J Thorac Cardiovasc Surg, 2013, 146(2): 358-364.
31.	張強. 胸腔鏡下肺段切除與肺葉切除治療早期非小細胞肺癌的療效及遠期預后分析. 福建醫科大學, 2021.
32.	劉文科, 董思遠, 別星星, 等. Ⅰ期非小細胞肺癌肺葉切除術及肺葉部分切除術術后生存的Meta分析. 現代腫瘤醫學, 2018, 26(14): 2191-2198.
33.	Zhang Y, Chen C, Hu J, et al. Early outcomes of robotic versus thoracoscopic segmentectomy for early-stage lung cancer: A multi-institutional propensity score-matched analysis. J Thorac Cardiovasc Surg, 2020, 160(5): 1363-1372.
34.	Casiraghi M, Sedda G, Diotti C, et al. Postoperative outcomes of robotic-assisted lobectomy in obese patients with non-small-cell lung cancer. Interact Cardiovasc Thorac Surg, 2020, 30(3): 359-365.
35.	徐惟, 許世廣, 李博, 等. 機器人肺癌根治術圍手術期并發癥及預防策略分析. 中華胸心血管外科雜志, 2020, 36(9): 539-542.
36.	楊子林, 徐惟, 許世廣, 等. 機器人肺癌術后胸腔引流時間影響因素分析及應對策略. 中國胸心血管外科臨床雜志, 2021, 28(5): 524-528.

1. Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: A secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
2. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
3. Lancaster HL, Heuvelmans MA, Oudkerk M. Low-dose computed tomography lung cancer screening: Clinical evidence and implementation research. J Intern Med, 2022, 292(1): 68-80.
4. Duma N, Santana-Davila R, Molina JR. Non-small cell lung cancer: Epidemiology, screening, diagnosis, and treatment. Mayo Clin Proc, 2019, 94(8): 1623-1640.
5. 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.
6. 周研, 張建平, 耿仲偉, 等. 解剖性肺段切除術與肺葉切除術治療磨玻璃結節樣非小細胞肺癌的療效分析. 局解手術學雜志, 2022, 31(3): 198-201.
7. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
8. 湯井雙, 黃晶晶, 李志華, 等. 肺葉切除術與肺段切除術治療直徑≤2 cm浸潤性肺腺癌的臨床效果分析. 南京醫科大學學報(自然科學版), 2022, 42(3): 387-392.
9. Bennett WF, Smith RA. Segmental resection for bronchogenic carcinoma: A surgical alternative for the compromised patient. Ann Thorac Surg, 1979, 27(2): 169-172.
10. Miller JI, Hatcher CR. Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function. Ann Thorac Surg, 1987, 44(4): 340-343.
11. 王俊, 趙輝. 亞肺葉切除治療早期肺癌需要考慮的幾個問題. 中國肺癌雜志, 2016, 19(6): 351-354.
12. Kirby TJ, Mack MJ, Landreneau RJ, et al. Initial experience with video-assisted thoracoscopic lobectomy. Ann Thorac Surg, 1993, 56(6): 1248-1252.
13. Walker WS, Carnochan FM, Pugh GC. Thoracoscopic pulmonary lobectomy. Early operative experience and preliminary clinical results. J Thorac Cardiovasc Surg, 1993, 106: 1111-1117.
14. 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.
15. 郭洪撥, 喻本桐. 機器人與胸腔鏡肺葉切除術在治療早期非小細胞肺癌的安全性與療效對比. 實用醫學雜志, 2019, 35(4): 541-545.
16. 柴新春, 許世廣, 劉博, 等. ⅠA期非小細胞肺癌行達芬奇機器人和電視胸腔鏡肺段切除術近期療效對比分析. 中華胸心血管外科雜志, 2021, 37(11): 644-648.
17. 齊凱, 曾惟標, 魏益平, 等. 胸腔鏡下肺段切除術與肺葉切除術治療Ⅰ期非小細胞肺癌遠期療效的Meta分析. 實用臨床醫學, 2021, 22(5): 18-23, 30.
18. 黃文海, 林志潮, 謝澤華, 等. 胸腔鏡肺葉切除術與肺段切除術治療早期肺癌的療效差異研究. 中國現代醫生, 2021, 59(16): 72-74, 78.
19. 燕曉光, 張軍, 羅衛民, 等. 微創肺葉切除術與微創肺段切除術治療早期非小細胞肺癌的臨床療效比較. 中國醫學工程, 2022, 30(7): 69-73.
20. 納迪爾·伊敏, 陸周一, 白赟彪, 等. 基于傾向性評分匹配法探討胸腔鏡下解剖性肺段切除與肺葉切除對術后患者肺功能影響. 中華胸心血管外科雜志, 2022, 38(1): 1-4.
21. 李小軍, 張璞, 薛鋒. 胸腔鏡微創外科與傳統手術治療原發性縱隔腫瘤的臨床療效及安全性比較. 貴州醫藥, 2021, 45(3): 372-373.
22. Melfi FM, Menconi GF, Mariani AM, et al. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg, 2002, 21(5): 864-868.
23. 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, 2016, 64(4): 354-362.
24. Wei S, Chen M, Chen N, et al. Feasibility and safety of robot-assisted thoracic surgery for lung lobectomy in patients with non-small cell lung cancer: A systematic review and meta-analysis. World J Surg Oncol, 2017, 15(1): 98.
25. 許世廣, 劉星池, 王希龍, 等. 應用達芬奇機器人手術系統肺切除技術總結. 中華胸部外科電子雜志, 2016, 3(2): 77-82.
26. 王述民. 機器人手術十年體會. 中華胸部外科電子雜志, 2021, 8(1): 1-5.
27. Nomori H, Yamazaki I, Machida Y, et al. Lobectomy versus segmentectomy: A propensity score-matched comparison of postoperative complications, pulmonary function and prognosis. Interact Cardiovasc Thorac Surg, 2022, 34(1): 57-65.
28. Carr SR, Schuchert MJ, Pennathur A, et al. Impact of tumor size on outcomes after anatomic lung resection for stage ⅠA non-small cell lung cancer based on the current staging system. J Thorac Cardiovasc Surg, 2012, 143(2): 390-397.
29. Moon MH, Moon YK, Moon SW. Segmentectomy versus lobectomy in early non-small cell lung cancer of 2 cm or less in size: A population-based study. Respirology, 2018, 23(7): 695-703.
30. Tsutani Y, Miyata Y, Nakayama H, et al. Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage ⅠA lung adenocarcinoma: Propensity score-matched analysis in a multicenter study. J Thorac Cardiovasc Surg, 2013, 146(2): 358-364.
31. 張強. 胸腔鏡下肺段切除與肺葉切除治療早期非小細胞肺癌的療效及遠期預后分析. 福建醫科大學, 2021.
32. 劉文科, 董思遠, 別星星, 等. Ⅰ期非小細胞肺癌肺葉切除術及肺葉部分切除術術后生存的Meta分析. 現代腫瘤醫學, 2018, 26(14): 2191-2198.
33. Zhang Y, Chen C, Hu J, et al. Early outcomes of robotic versus thoracoscopic segmentectomy for early-stage lung cancer: A multi-institutional propensity score-matched analysis. J Thorac Cardiovasc Surg, 2020, 160(5): 1363-1372.
34. Casiraghi M, Sedda G, Diotti C, et al. Postoperative outcomes of robotic-assisted lobectomy in obese patients with non-small-cell lung cancer. Interact Cardiovasc Thorac Surg, 2020, 30(3): 359-365.
35. 徐惟, 許世廣, 李博, 等. 機器人肺癌根治術圍手術期并發癥及預防策略分析. 中華胸心血管外科雜志, 2020, 36(9): 539-542.
36. 楊子林, 徐惟, 許世廣, 等. 機器人肺癌術后胸腔引流時間影響因素分析及應對策略. 中國胸心血管外科臨床雜志, 2021, 28(5): 524-528.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The efficacy of da Vinci robot-assisted lobectomy versus segmentectomy for stage ⅠA non-small cell lung cancer: A retrospective cohort study

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