Clinical efficacy of robot versus video-assisted thoracoscopic surgery for the treatment of mediastinal tumor: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CAO Wei ^1,2,3 , LI Haochi ^1,2,3 , YANG Kai ^2,3 , WANG Qi ^2,3 , ZUO Zhuang ^2,3 ,  GOU Yunjiu ^2,3

1. First Clinical Medical School, Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
2. Chest Clinic Center, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;
3. First Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;

Corresponding?author：

GOU Yunjiu, Email: gouyunjiu@163.com

Keywords：

Robot-assisted thoracic surgery; video-assisted thoracoscopic surgery; mediastinal neoplasms; clinical efficacy; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202405061

Video：

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Objective To systematically evaluate the therapeutic effects of video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracic surgery (RATS) in treating mediastinal tumors. Methods A computer search was conducted on PubMed, Embase, Cochrane Library, Web of Science, Wanfang, CNKI, CBM, VIP databases for literature comparing the clinical efficacy of VATS and RATS in treating mediastinal tumors, with the search time from inception to March 31, 2024. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included cohort studies, and Review Manager 5.4 software was used to perform a meta-analysis. Results A total of 32 articles were included, with 7868 patients. The NOS scores of the included cohort studies were all≥7 points. Meta-analysis results showed that compared with the VATS group, the RATS group had less intraoperative blood loss [MD=?16.71, 95%CI (?23.88, ?9.54), P<0.001], lower conversion rate to open thoracotomy [OR=0.41, 95%CI (0.26, 0.67), P=0.003], lower overall postoperative complication rate [OR=0.66, 95%CI (0.48, 0.92), P=0.01], shorter postoperative drainage time [MD=?0.64, 95%CI (?0.92, ?0.36), P<0.001], and shorter postoperative hospital stay [MD=?1.03, 95%CI (?1.28, ?0.78), P<0.001]. There was no statistical difference between the two groups in terms of tumor size [MD=?0.06, 95%CI (?0.31, 0.19), P=0.64] or operation time [MD=5.52, 95%CI (?2.35, 13.40), P=0.17]. The RATS group had higher hospitalization costs than the VATS group [MD=1.69, 95%CI (1.26, 2.13), P<0.001]. Conclusion In mediastinal tumors resection, RATS is superior to VATS in terms of intraoperative blood loss, conversion rate to open thoracotomy, overall postoperative complication rate, postoperative drainage time, and postoperative hospital stay, but it increases hospitalization costs.

Citation： CAO Wei, LI Haochi, YANG Kai, WANG Qi, ZUO Zhuang, GOU Yunjiu. Clinical efficacy of robot versus video-assisted thoracoscopic surgery for the treatment of mediastinal tumor: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(5): 799-806. doi: 10.7507/1007-4848.202405061 Copy

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1. Zhou D, Liu QX, Zheng H, et al. Postoperative radiotherapy for completely resected thymoma: differing roles in masaoka stageⅡand stageⅢdisease. Asian J Surg, 2022, 45(12): 2670-2675.
2. 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.Preparatory Group of Thoracic Surgery Committee, Chinese Society of Medical Robotic Physicians, Tan QY, Tang SL, et al. Chinese expert consensus on robot-assisted surgery for mediastinal tumors (2019 edition). Chin J Clin Thorac Cardiovasc Surg, 2020, 27(2): 117-125.
3. Asaf BB, Bishnoi S, Vardhanpuri H, et al. Robotic excision of posterior mediastinal neurogenic tumours: technique and surgical outcomes. J Minim Access Surg, 2024, 20(2): 136-141.
4. Hong Z, Gou W, Cui B, et al. Analysis of the efficacy of the da Vinci robot in surgery for posterior mediastinal neurogenic tumors. BMC Surg, 2022, 22(1): 413.
5. Ye B, Tantai JC, Ge XX, et al. Surgical techniques for early-stage thymoma: video-assisted thoracoscopic thymectomy versus transsternal thymectomy. J Thorac Cardiovasc Surg, 2014, 147(5): 1599-1603.
6. Jiang L, Chen H, Hou Z, et al. Subxiphoid versus unilateral video-assisted thoracoscopic surgery thymectomy for thymomas: a propensity score matching analysis. Ann Thorac Surg, 2022, 113(5): 1656-1662.
7. Chendaer N, Jiang N, Hao Y, et al. A propensity score-matching analysis: robotic thymectomy through the subxiphoid has advantages over video-assisted thymectomy surgery. J Laparoendosc Adv Surg Tech A, 2023, 33(9): 859-865.
8. Chen K, Zhang X, Jin R, et al. Robot-assisted thoracoscopic surgery for mediastinal masses: a single-institution experience. J Thorac Dis, 2020, 12(2): 105-113.
9. Nguyen TG, Nguyen NT, Nguyen VN, et al. Video-assisted thoracoscopic surgery for myasthenia gravis with thymoma: a six-year single-center experience. Asian J Surg, 2021, 44(1): 369-373.
10. Sholtis C, Teymourtash M, Berry M, et al. Transcervical thymectomy is the most cost-effective surgical approach in myasthenia gravis. Ann Thorac Surg, 2020, 109(6): 1705-1712.
11. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
12. Chao YK, Lee JY, Lu HI, et al. Robot-assisted surgery outperforms video-assisted thoracoscopic surgery for anterior mediastinal disease: a multi-institutional study. J Robot Surg, 2024, 18(1): 21.
13. Chiba Y, Miyajima M, Takase Y, et al. Robot-assisted and video-assisted thoracoscopic surgery for thymoma: comparison of the perioperative outcomes using inverse probability of treatment weighting method. Gland Surg, 2022, 11(8): 1287-1300.
14. El-Akkawi AI, Eckardt J. Comparison of surgical outcomes after robotic assisted thoracic surgery, video-assisted thoracic surgery and open resection of thymoma. Mediastinum, 2021, 5: 11.
15. Hong Z, Sheng Y, Cui B, et al. A comparative study of robotic surgery and thoracoscopic surgery for mediastinal cysts. BMC Surg, 2023, 23(1): 102.
16. Imielski B, Kurihara C, Manerikar A, et al. Comparative effectiveness and cost-efficiency of surgical approaches for thymectomy. Surgery, 2020, 168(4): 737-742.
17. Jiang B, Tan QY, Deng B, et al. Robot-assisted thymectomy in large anterior mediastinal tumors: a comparative study with video-assisted thymectomy and open surgery. Thorac Cancer, 2023, 14(3): 267-273.
18. Jun Y, Hao L, Demin L, et al. Da Vinci robot-assisted system for thymectomy: experience of 55 patients in China. Int J Med Robot, 2014, 10(3): 294-299.
19. Kamel MK, Villena-Vargas J, Rahouma M, et al. National trends and perioperative outcomes of robotic resection of thymic tumours in the United States: a propensity matching comparison with open and video-assisted thoracoscopic approaches. Eur J Cardiothorac Surg, 2019, 56(4): 762-769.
20. Li XK, Xu Y, Cong ZZ, et al. Comparison of the progression-free survival between robot-assisted thymectomy and video-assisted thymectomy for thymic epithelial tumors: a propensity score matching study. J Thorac Dis, 2020, 12(8): 4033-4043.
21. Li R, Ma Z, Qu C, et al. Comparison of perioperative outcomes between robotic-assisted and video-assisted thoracoscopic surgery for mediastinal masses in patients with different body mass index ranges: a population-based study. Front Surg, 2022, 9: 963335.
22. Ochi T, Suzuki H, Hirai Y, et al. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for mediastinal lesions. J Thorac Dis, 2023, 15(7): 3840-3848.
23. Qian L, Chen X, Huang J, et al. A comparison of three approaches for the treatment of early-stage thymomas: robot-assisted thoracic surgery, video-assisted thoracic surgery, and median sternotomy. J Thorac Dis, 2017, 9(7): 1997-2005.
24. Raja SM, Guptill JT, McConnell A, et al. Perioperative outcomes of thymectomy in myasthenia gravis: a thoracic surgery database analysis. Ann Thorac Surg, 2022, 113(3): 904-910.
25. Rowse PG, Roden AC, Corl FM, et al. Minimally invasive thymectomy: the Mayo Clinic experience. Ann Cardiothorac Surg, 2015, 4(6): 519-526.
26. Rückert JC, Swierzy M, Ismail M. Comparison of robotic and nonrobotic thoracoscopic thymectomy: a cohort study. J Thorac Cardiovasc Surg, 2011, 141(3): 673-677.
27. Salfity HV, Timsina L, Ceppa DP, et al. Minimally invasive surgery in the management of resectable thymoma: a retrospective analysis from the National Cancer Database. J Thorac Dis, 2021, 13(11): 6353-6362.
28. ?ehitogullari A, Nas?r A, Anbar R, et al. Comparison of perioperative outcomes of videothoracoscopy and robotic surgical techniques in thymoma. Asian J Surg, 2020, 43(1): 244-250.
29. Suda T, Kaneda S, Hachimaru A, et al. Thymectomy via a subxiphoid approach: single-port and robot-assisted. J Thorac Dis, 2016, 8(Suppl 3): S265-S271.
30. Ye B, Tantai JC, Li W, et al. Video-assisted thoracoscopic surgery versus robotic-assisted thoracoscopic surgery in the surgical treatment of Masaoka stageⅠthymoma. World J Surg Oncol, 2013, 11: 157.
31. 丁仁泉, 童向東, 許世廣, 等. 達芬奇機器人手術系統與電視胸腔鏡在胸內縱隔疾病手術治療中的對比研究. 中國肺癌雜志, 2014, 17(7): 557-562.Ding RQ, Tong XD, Xu SG, et al. A comparative study of da Vinci robot system with video-assisted thoracoscopy in the surgical treatment of mediastinal lesions. Chin J Lung Cancer, 2014, 17(7): 557-562.
32. 井淼, 蔡文涵, 溫佳新, 等. 達芬奇機器人與電視胸腔鏡治療縱隔神經源性腫瘤的對比研究. 中華腔鏡外科雜志(電子版), 2022, 15(3): 163-167.Jing M, Cai WH, Wen JX, et al. Comparison of clinical outcomes of da Vinci robot-assisted and video-assisted thoracoscopic surgery for mediastinal neurogenic tumors. Chin J Laparosc Surg (Electron Ed), 2022, 15(3): 163-167.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical efficacy of robot versus video-assisted thoracoscopic surgery for the treatment of mediastinal tumor: A systematic review and meta-analysis

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