1
|
Dang J, Sun S, Wu Z, Shan Y, Zhang H. Meta-analysis of clinical efficacy of thoracoscopy and robotic surgery in the treatment of mediastinal tumors. World J Surg Oncol 2024; 22:70. [PMID: 38413953 PMCID: PMC10900664 DOI: 10.1186/s12957-024-03325-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/23/2024] [Indexed: 02/29/2024] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Shize Sun
- Wuwei Liangzhou Hospital, Gansu, China
| | | | | | | |
Collapse
|
2
|
Zheng C, Ge Y, Ma T, Pan J, Zhang X, Sun T, Feng S, Zhang H. Outcomes of robot-assisted versus video-assisted mediastinal mass resection during the initial learning curve. J Robot Surg 2024; 18:81. [PMID: 38367155 PMCID: PMC10874309 DOI: 10.1007/s11701-024-01828-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/14/2024] [Indexed: 02/19/2024]
Abstract
To compare the learning curve of mediastinal mass resection between robot-assisted surgery and thoracoscopic surgery. Retrospective perioperative data were collected from 160 mediastinal mass resection cases. Data included 80 initial consecutive video-assisted thoracoscopic surgery (VATS) resection cases performed from February 2018 to February 2020 and 80 initial consecutive robotic-assisted thoracic surgery (RATS) resection cases performed from March 2020 to March 2023. All cases were operated on by a thoracic surgeon. The clinical characteristics and perioperative outcomes of the two groups were compared. The operation time in both the RATS group and VATS group was analyzed using the cumulative sum (CUSUM) method. Based on this method, the learning curves of both groups were divided into a learning period and mastery period. The VATS group and the RATS group crossed the inflection point in the 27th and 21st case, respectively. Subsequently, we found that the learning period was longer than the mastery period with statistically significant differences in terms of the operating time, and postoperative hospital stay in the VATS group and the RATS group. A certain amount of VATS experience can shorten the learning curve for RATS.
Collapse
Affiliation(s)
- Chengwen Zheng
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221003, Jiangsu, China
| | - Yong Ge
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221003, Jiangsu, China
| | - Tianyue Ma
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221003, Jiangsu, China
| | - Jiajian Pan
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221003, Jiangsu, China
| | - Xueqiu Zhang
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221003, Jiangsu, China
| | - Teng Sun
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221003, Jiangsu, China
| | - Shoujie Feng
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221003, Jiangsu, China
| | - Hao Zhang
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China.
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221003, Jiangsu, China.
| |
Collapse
|
3
|
Pang J, Xiu W, Ma X. Application of Artificial Intelligence in the Diagnosis, Treatment, and Prognostic Evaluation of Mediastinal Malignant Tumors. J Clin Med 2023; 12:jcm12082818. [PMID: 37109155 PMCID: PMC10144939 DOI: 10.3390/jcm12082818] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/01/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Artificial intelligence (AI), also known as machine intelligence, is widely utilized in the medical field, promoting medical advances. Malignant tumors are the critical focus of medical research and improvement of clinical diagnosis and treatment. Mediastinal malignancy is an important tumor that attracts increasing attention today due to the difficulties in treatment. Combined with artificial intelligence, challenges from drug discovery to survival improvement are constantly being overcome. This article reviews the progress of the use of AI in the diagnosis, treatment, and prognostic prospects of mediastinal malignant tumors based on current literature findings.
Collapse
Affiliation(s)
- Jiyun Pang
- Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Weigang Xiu
- Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Xuelei Ma
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
4
|
Lacquet M, Moons J, Ceulemans LJ, De Leyn P, Van Raemdonck D. Surgery for mediastinal neurogenic tumours: a 25-year single-centre retrospective study. Interact Cardiovasc Thorac Surg 2021; 32:737-743. [PMID: 33517410 DOI: 10.1093/icvts/ivab002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/30/2020] [Accepted: 12/12/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Mediastinal neurogenic tumours are uncommon and often benign neoplasms mostly located in the posterior mediastinum and usually diagnosed incidentally. We reviewed our results after surgical resection. We compared patient characteristics and tumour nature between children and adults. Differences between thoracoscopic and open approach were analysed. METHODS Departmental thoracic surgical database was queried for primary mediastinal neurogenic tumours resected between 1992 and 2017. Data included demographics, pathology, tumour nature, symptoms, surgical approach and postoperative morbidity/mortality. RESULTS Fifty-one patients (8 children and 43 adults) underwent tumour resection. Pathology revealed nerve sheath tumour in 1 child (12.5%) versus 36 adults (83.7%; P < 0.001) and ganglion cell tumour in 7 (87.5%) versus 5 (11.6%; P < 0.001). Two adults had a paraganglioma. Malignancy was present in 2 children (25%) versus 2 adults (4.6%; P = 0.049). All malignant tumours caused symptoms while most patients with benign tumours (38/47) were asymptomatic (P < 0.001). Surgical approach included thoracotomy, thoracoscopy and cervicotomy (n = 19/31/1) of which 2 were combined neurosurgical approach. All malignant tumours were approached via thoracotomy while the majority of patients with benign tumours (31/47) underwent thoracoscopy (P = 0.007). No significant difference was noted in overall morbidity between thoracoscopic versus open approach (45.2% vs 42.1%; P = 0.83). Hospital stay was significantly shorter following thoracoscopy (7.4 ± 3.3 vs 13.1 ± 9.8 days; P = 0.001). CONCLUSIONS Children carry a higher incidence to present with a malignant tumour originating from ganglion cells while most tumours in adults are benign, originating from the nerve sheath. The majority of patients with mediastinal neurogenic tumours are asymptomatic. Most tumours are amenable for thoracoscopic resection.
Collapse
Affiliation(s)
- Mathieu Lacquet
- Surgical Resident, Competence Center for Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory for Respiratory Diseases and Thoracic Surgery (BREATHE), Catholic University Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory for Respiratory Diseases and Thoracic Surgery (BREATHE), Catholic University Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory for Respiratory Diseases and Thoracic Surgery (BREATHE), Catholic University Leuven, Leuven, Belgium
| |
Collapse
|
5
|
Mlika M, Marghli A, Souilem I, Houcine Y, Abdennadher M, Braham E, Ayadi A, Mezni F. A single-institution experience of neurogenic tumors of the mediastinum. Asian Cardiovasc Thorac Ann 2019; 27:661-669. [PMID: 31533441 DOI: 10.1177/0218492319878575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Neurogenic tumors of the mediastinum are rare tumors located mainly in the posterior mediastinum. The aim of this study was to report a single-institution experience of these tumors. Methods This study was conducted between 2005 and 2017. Bivariate analysis was performed to assess correlations between the cellularity, mitotic index, presence of a capsule, and potential for malignancy of peripheral nerve sheath tumors. Results There were 86 patients enrolled in the study. The mean age was 42.51 years. Nineteen patients were asymptomatic and their tumors were discovered incidentally. Microscopic diagnosis confirmed a schwannoma in 45 cases, neurofibroma in 12, malignant peripheral nerve sheath tumor in 9, ganglioneuroma in 14, ganglioneuroblastoma in 4, and neuroblastoma in 2. Bivariate analysis showed a significant correlation between the absence of a capsule, the degree of atypia, a high mitotic index, and high cellularity with the potential for malignancy ( p < 0.05). Surgical resection was the main treatment modality in 84 cases. The mean survival was estimated to be 51.309 months. The log-rank test showed a significant difference in survival according to histologic subtype and between benign and malignant tumors ( p < 0.0001). Conclusion Even if radiologic means are helpful in suggesting the diagnosis, a positive diagnosis of neurogenic tumors is based on microscopic features. High mitotic activity and cellularity, and severe cytonuclear atypia are the features most suggestive of malignancy.
Collapse
Affiliation(s)
- Mouna Mlika
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Department of Pathology, Abderrahman Mami Hospital, Tunis, Tunisia
| | - Adel Marghli
- Department of Thoracic Surgery, Abderrahman Mami Hospital, Tunis, Tunisia
| | - Ines Souilem
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Department of Pathology, Abderrahman Mami Hospital, Tunis, Tunisia
| | - Yoldez Houcine
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Department of Pathology, Abderrahman Mami Hospital, Tunis, Tunisia
| | - Mehdi Abdennadher
- Department of Thoracic Surgery, Abderrahman Mami Hospital, Tunis, Tunisia
| | - Emna Braham
- Department of Pathology, Abderrahman Mami Hospital, Tunis, Tunisia
| | - Aida Ayadi
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Department of Pathology, Abderrahman Mami Hospital, Tunis, Tunisia
| | - Faouzi Mezni
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Department of Pathology, Abderrahman Mami Hospital, Tunis, Tunisia
| |
Collapse
|