Effects of da Vinci robot versus thoracoscopic surgery on body trauma and lymphocyte subsets in lung cancer patients: A propensity score matching study

Changes in the immune index before and after surgery in urinary malignancy patients with AIDS

The immune index is an important marker of HIV immune function. Long-term clinical experience revealed that in urinary malignancy patients with AIDS who underwent radical surgery for malignant tumors, the preoperative and postoperative immune indices changed to different degrees, which affected patient prognosis. A total of 48 AIDS patients who underwent radical resection of malignant tumors in the Department of Urology of Beijing You 'an Hospital between 2015 and 2023 were included, including 25 patients with kidney cancer, 12 patients with bladder cancer and 11 patients with prostate cancer. A paired t test was used to study the changes in the immune indices CD4 + T, CD8 + T, CD3 + T and CD4+/CD8 + T cells before and after surgery for different malignant tumors in the urinary tract. The chi-square test was used to study the effects of clinical variables such as age, sex, hypertension status, diabetes status, duration of operation, duration of HIV infection, duration of medication and viral load on preoperative and postoperative immune indices. The area under the ROC curve of the four immune indicators before and after surgery was compared to evaluate the influence of immune indicators on patient prognosis. Survival curves were drawn to study the prognostic risk of immune indicators. The mean CD4 + T, CD8 + T and CD3 + T-cell counts decreased before and after surgery in patients with renal, bladder and prostate cancer, and P < 0.05 according to paired t tests indicated statistical significance, while the CD4+/CD8 + T-cell ratio was not significantly different according to paired t tests. Clinical variables such as age, sex, hypertension status, diabetes status, duration of operation, duration of HIV infection, duration of medication and viral load had no statistically significant effects on the preoperative or postoperative immune indices. The area under the ROC curve of the four immune indices was compared, and the results showed that CD8 + T cells [preoperative AUC of 0.678 (P < 0.05) and postoperative AUC of 0.702 (P < 0.05)] were superior to the other indices. Survival curve analysis revealed that a decrease in CD4 + T, CD8 + T and CD3 + T cells after surgery led to a decrease in the survival rate of patients, but the results were not statistically significant. CD4 + T, CD8 + T and CD3 + T cells decreased before and after surgery in patients with malignant tumors of the urinary system complicated with AIDS, and CD8 + T cells had a statistically significant effect on patient prognosis compared with other immune indices.

Feasibility of Robot-Assisted Cytoreductive Surgery With Upper-Abdominal Peritonectomy for Pseudomyxoma Peritonei With Low Peritoneal Carcinomatosis Index: A Pilot Study

INTRODUCTION

Our study's objective was to provide the method for, and preliminary findings from, robot-assisted cytoreductive surgery (r-CRS) combined with upper-abdominal peritonectomy in pseudomyxoma peritonei (PMP) with limited peritoneal surface malignancy (PSM).

MATERIALS AND METHODS

We conducted a retrospective pilot study on consecutive patients with PSM secondary to pseudomyxoma peritonei with a peritoneal cancer index (PCI) of under 10 who were indicated for r-CRS combined with upper-abdominal peritectomy. Perioperative and 30-day major morbidity and mortality characteristics were analyzed and compared with cases in which laparoscopic CRS (l-CRS) was performed under the same conditions.

RESULTS

Six patients underwent r-CRS combined with an upper-abdominal partial peritonectomy. Their mean PCI was 4.83. Complete cytoreduction was achieved in all patients. The mean duration of the operation was 156.8 minutes. There was no major complication and no mortality. The mean length of hospital stay after surgery was 6.33 days. r-CRS resulted in less blood loss, a lower C-reactive protein level, and a shorter length of hospital stay that were significantly different compared with those of l-CRS.

CONCLUSIONS

This is the initial technical report of a robotic approach for CRS combined with upper-abdominal peritonectomy. r-CRS with a combined upper-abdominal peritonectomy was shown to be safe and feasible for PMP with limited PSM.

Meta-analysis of clinical efficacy of thoracoscopy and robotic surgery in the treatment of mediastinal tumors

OBJECTIVE

Comparing the clinical efficacy of thoracoscopy and robotic surgery in the treatment of mediastinal tumors using meta-analysis.

METHODS

Computer retrieval of PubMed, Embase, The Cochrane Library, and Web of Science databases for literature comparing the clinical effects of video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS) in treating mediastinal tumors, with the retrieval time limit from the establishment of the database to September 2023. Two evaluators independently screened the literature, extracted data, and assessed the risk of bias. Meta-analysis was performed using RevMan 5.4.

RESULTS

A total of 19 articles were included, with a total of 3517 patients. The results of the Meta-analysis showed that the RATS group had less intraoperative bleeding [MD =  - 5.20, 95%CI (- 9.28, - 1.12), P = 0.01], lower rate of conversion to thoracotomy [OR = 0.41, 95%CI (0.23, 0.72), P = 0.002], lower rate of total postoperative complications [OR = 0.57, 95%CI (0.34, 0.95), P = 0.03], shorter postoperative drainage time [MD =  - 0.72, 95%CI (- 1.13, - 0.32), P = 0.0004], and shorter postoperative hospital stay [MD =  - 0.90, 95%CI (- 1.16, - 0.65), P < 0.001], in comparison with the VATS group. There was an insignificant difference between the two groups in terms of tumor size [MD =  - 0.02, 95%CI (- 0.33, 0.30), P = 0.91] and operation time [MD = 0.17, 95%CI (- 7.61, 7.94), P = 0.97]. However, in regards to hospitalization costs [MD = 2634.75, 95%CI (991.62, 4277.88), P = 0.002], the RATS group was more expensive than the VATS group.

CONCLUSION

Robot-assisted mediastinal tumor resection surgery has more advantages in terms of intraoperative bleeding, conversion to thoracotomy rate, total postoperative complication rate, postoperative drainage time, and postoperative hospital stay, in comparison with thoracoscopic-assisted mediastinal tumor resection surgery. There is an insignificant difference in tumor size and operation time between the two surgeries. However, robot-assisted mediastinal tumor resection surgery increases hospitalization costs.