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Haruki T, Kubouchi Y, Kidokoro Y, Matsui S, Ohno T, Kojima S, Nakamura H. A comparative study of robot-assisted thoracoscopic surgery and conventional approaches for short-term outcomes of anatomical segmentectomy. Gen Thorac Cardiovasc Surg 2024; 72:338-345. [PMID: 37934374 PMCID: PMC11018688 DOI: 10.1007/s11748-023-01983-y] [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: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES Since anatomical segmentectomy requires meticulous dissection of the segmental pulmonary vessels and bronchus, robot-assisted thoracoscopic surgery (RATS) has been widely adopted in recent years. We investigated the usefulness of RATS segmentectomy by comparing perioperative outcomes with conventional approaches including open thoracotomy or video-assisted thoracoscopic surgery (VATS). We compared perioperative outcomes of segmentectomy between RATS and conventional approaches including open thoracotomy or video-assisted thoracoscopic surgery (VATS). METHODS This single-institutional retrospective study comprised 231 patients with primary lung cancer who underwent segmentectomy by RATS or conventional approaches between January 2011 and December 2022. Surgical outcomes and postoperative complications were analyzed among patients whose background factors were adjusted by propensity score matching (PSM). RESULTS Before PSM, there were significant differences in age, smoking status, and types of segmentectomy. After PSM, 126 patients (63 patients in each group) were included in this analysis. The RATS group had significantly shorter operative time (154 vs 210 min; p < 0.01), fewer bleeding amounts (10 vs 40 mL; p < 0.01), and shorter duration of chest drainage (2 vs 2 days; p = 0.04) than the conventional-approach group. There was no significant difference in the incidence of all complications; however, the incidence of postoperative pneumonia was significantly lower than in the conventional-approach group (p = 0.02). CONCLUSIONS RATS segmentectomy is proposed to be useful. It was suggested that RATS segmentectomy may be useful with better perioperative results than the conventional approach. Further studies on oncological long-term outcomes and cost-benefit comparisons are needed.
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Affiliation(s)
- Tomohiro Haruki
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
| | - Yasuaki Kubouchi
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Yoshiteru Kidokoro
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Shinji Matsui
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Takashi Ohno
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Shunsuke Kojima
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Hiroshige Nakamura
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
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Liu S, Huang H, Zhang C, Chen L, Feng X, Wu Y, Xia Q, Huang X. Postoperative leukocyte counts as a surrogate for surgical stress response in matched robot- and video-assisted thoracoscopic surgery cohorts of patients: A preliminary report. J Robot Surg 2024; 18:176. [PMID: 38630145 PMCID: PMC11024030 DOI: 10.1007/s11701-024-01939-1] [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: 02/15/2024] [Accepted: 03/31/2024] [Indexed: 04/19/2024]
Abstract
The objective is to preliminary evaluated postoperative leukocyte counts as a surrogate for the surgical stress response in NSCLC patients who underwent RATS or VATS for further prospective analyses with proper assessment of surgical stress response and tissue trauma. We retrospectively analyzed patients with stageI-IIIA NSCLC who underwent RATS or VATS at a hospital between 8 May 2020 and 31 December 2021. Analysis of leukocytes (including neutrophils and lymphocytes) and albumin on postoperative days (PODs) 1 and 3 in patients with NSCLC treated with RATS or VATS after propensity score matching (PSM). In total, 1824 patients (565 RATS and 1259 VATS) were investigated. The two MIS groups differed significantly with regard to operative time (p < 0.001), chronic lung disease (p < 0.001), the type of pulmonary resection (p < 0.001), the excision site of lobectomy (p = 0.004), and histology of the tumor (p = 0.028). After PSM, leukocyte and neutrophil levels in the RATS group were lower than those in the VATS group on PODs 1 and 3, with those on POD 3 (p < 0.001) being particularly notable. While lymphocyte levels in the RATS group were significantly lower than those in the VATS group only at POD 1 (p = 0.016). There was no difference in albumin levels between the RATS and VATS groups on PODs 1 and 3. The surgical stress response and tissue trauma was less severe in NSCLC patients who underwent RATS than in those who underwent VATS, especially reflected in the neutrophils of leukocytes.
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Affiliation(s)
- Sidi Liu
- Infection Control Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Huichao Huang
- Department of Infectious Diseases, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Chunfang Zhang
- Department of Thoracic Surgery, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Letao Chen
- Infection Control Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Xuelian Feng
- Operating Room Department, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Yaling Wu
- Infection Control Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, China
- Disease Prevention and Control Section, Anfu People's Hospital, Jian, China
| | - Qing Xia
- Infection Control Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, China
- Disease Prevention and Control Section, 921 Hospital of Joint Logistics Support Force, Changsha, China
| | - Xun Huang
- Infection Control Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China.
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Xu H, Zhang L. Assessment of Quality Outcomes and the Learning Curve for Robot-Assisted Anatomical Lung Resections. J Laparoendosc Adv Surg Tech A 2024; 34:67-76. [PMID: 38126882 DOI: 10.1089/lap.2023.0171] [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] [Indexed: 12/23/2023] Open
Abstract
Background: To determine the perioperative quality assessment results and learning curves for robot-assisted anatomical lung resection. Methods: We analyzed the data of the initial 400 patients who underwent lobectomies or segmentectomies by 1 surgeon from January 2020 to November 2021. The learning curve was analyzed using cumulative sum analysis. Results: The surgical experience was divided into an initial phase (1st-40th procedures), a transition phase (41st-131st procedures), and a proficient phase (132nd procedure onward). The operative time showed a conspicuously continuous improvement over the 400 consecutive patients. After the 120th procedure, there were significant improvements in the rate of persistent air leakage (11.7% versus 3.9%; P = .003), chest tube duration (3.92 ± 1.91 versus 2.99 ± 1.31, P = .00), and postoperative hospital stay (6.22 ± 2.02 versus 4.93 ± 1.44, P = .00). Conclusions: In conclusion, 40 patients were necessary to pass the learning curve, and technical proficiency with favorable perioperative outcomes was achieved after 120-130 patients.
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Affiliation(s)
- Hao Xu
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, China
| | - Linyou Zhang
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, China
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Baldonado JJAR, Naffouje SA, Parvathaneni S, Roy E, Toloza EM, Fontaine JP. Outcomes of robotic lobectomy for non-small cell lung cancer in a National Cancer Institute-Comprehensive Cancer Center vs. National Cancer Database. J Thorac Dis 2023; 15:5349-5361. [PMID: 37969299 PMCID: PMC10636448 DOI: 10.21037/jtd-22-1340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 08/04/2023] [Indexed: 11/17/2023]
Abstract
Background There continues to be a rise in the proportion of resectable non-small cell lung cancer (NSCLC) with the recent expansion of criteria for low-dose lung cancer screening. These are increasingly being treated with minimally invasive techniques. Our study aims to compare outcomes of robotic lobectomy (RL) for NSCLC at a National Cancer Institute-designated Comprehensive Cancer Center (NCI-CCC) to those of open lobectomy (OL), video-assisted thoracoscopic lobectomy (VL), or RL as reported in the National Cancer Database (NCDB). Methods The first 1,021 patients with NSCLC who underwent RL between 2010 and 2020 were matched with peers from the NCDB who had OL, VL, or RL. Matching was performed based on a propensity score calculated by logistic regression using multiple variables. Surgical outcomes included numbers of examined lymph nodes, performance of mediastinal lymphadenectomy, length of stay (LOS), and 30-day mortality. Kaplan-Meier curves and overall survival (OS) were analyzed using log-rank tests. Results Most common postoperative complications were persistent air leak, atrial fibrillation, and pneumonia. Median LOS was 4 days, and the 30-day mortality rate was 1% (n=10/1,021). Compared to NCDB patients who underwent OL, NCI-CCC patients had a higher mean number of retrieved lymph nodes (P=0.001), higher rate of mediastinal lymphadenectomy (P<0.001), and shorter median LOS (4 vs. 6 days; P<0.001). There was no difference in 30-day mortality (P=0.176). Kaplan-Meier analyses showed no differences in median OS (log-rank P=0.953) or 5-year OS (P=0.774). Compared to NCDB VL, NCI-CCC patients had a higher nodal yield (P<0.001), higher rates of mediastinal lymphadenectomy (P<0.001), and lower conversion rates (4.1% vs. 13.8%, P<0.001). There were no differences in 30-day mortality (P=0.379) or in median LOS (P=0.351). Kaplan-Meier analyses showed no differences in median OS (P=0.720) or 5-year OS (P=0.735). NCI-CCC patients were also matched with NCDB RL patients and had a higher nodal yield (P<0.001), higher rates of mediastinal lymphadenectomy (P<0.001), and lower conversion rates (4.1% vs. 9.5%; P <0.001). There were no differences in 30-day mortality (P=0.899) or in median LOS (P=0.252). Kaplan-Meier analyses showed no differences in median OS (P=0.484) or 5-year OS (P=0.524). Conclusions RL for NSCLC performed in an NCI-CCC appears to have improved perioperative outcomes with comparable long-term OS compared to national benchmarks in OL and VL.
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Affiliation(s)
- Jobelle J. A. R. Baldonado
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Departments of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Samer A. Naffouje
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Esha Roy
- Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Eric M. Toloza
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Departments of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Jacques P. Fontaine
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Departments of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
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Ichinose J, Hashimoto K, Matsuura Y, Nakao M, Okumura S, Mun M. Initial perioperative outcomes of robot-assisted thoracoscopic lobectomy using a confronting setting. Surg Today 2023; 53:1073-1080. [PMID: 36828911 DOI: 10.1007/s00595-023-02665-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/30/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE Most robot-assisted thoracoscopic surgery (RATS) is performed from the vertical view. This study evaluates the initial outcomes of our novel confronting RATS technique, in which the patient was viewed horizontally, as in open thoracotomy. METHODS We reviewed data on patients who underwent thoracoscopic lobectomy between January, 2019 and April, 2022. Perioperative outcomes were compared between RATS and video-assisted thoracoscopic surgery (VATS), using propensity-score matching. RESULTS RATS and VATS were performed for 83 and 571 patients, respectively. After propensity-score matching, data on 81 patients from each of the two groups were retrieved. The operative time was significantly longer for RATS than for VATS (199 ± 44 min vs. 173 ± 37 min, p < 0.001). There was no mortality or conversion to thoracotomy in either of the groups. The rates of overall complications and prolonged air leak did not differ significantly between the groups. The serum creatine phosphokinase level on postoperative day 4 was higher after RATS than after VATS. The number of resected lymph nodes and the rates of nodal upstaging did not differ significantly between the groups. CONCLUSION The initial perioperative outcomes of RATS using the confronting settings were comparable to those of VATS.
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Affiliation(s)
- Junji Ichinose
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Kohei Hashimoto
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Ureña A, Moreno C, Macia I, Rivas F, Déniz C, Muñoz A, Serratosa I, García M, Masuet-Aumatell C, Escobar I, Ramos R. A Comparison of Total Thoracoscopic and Robotic Surgery for Lung Cancer Lymphadenectomy. Cancers (Basel) 2023; 15:3442. [PMID: 37444555 DOI: 10.3390/cancers15133442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Robotic-assisted thoracic surgery (RATS) is used increasingly frequently in major lung resection for early stage non-small-cell lung cancer (NSCLC) but has not yet been fully evaluated. The aim of this study was to compare the surgical outcomes of lymph node dissection (LND) performed via RATS with those from totally thoracoscopic (TT) four-port videothoracoscopy. METHODS Clinical and pathological data were collected retrospectively from patients with clinical stage N0 NSCLC who underwent pulmonary resection in the form of lobectomy or segmental resection between June 2010 and November 2022. The assessment criteria were number of mediastinal lymph nodes and number of mediastinal stations dissected via the RATS approach compared with the four-port TT approach. RESULTS A total of 246 pulmonary resections with LND for clinical stages I-II NSCLC were performed: 85 via TT and 161 via RATS. The clinical characteristics of the patients were similar in both groups. The number of mediastinal nodes dissected and mediastinal stations dissected was significantly higher in the RATS group (TT: mean ± SD, 10.72 ± 3.7; RATS, 14.74 ± 6.3 [p < 0.001]), except in the inferior mediastinal stations. There was no difference in terms of postoperative complications. CONCLUSIONS In patients with early stage NSCLC undergoing major lung resection, the quality of hilomediastinal LND performed using RATS was superior to that performed using TT.
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Affiliation(s)
- Anna Ureña
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Department of Thoracic Surgery, Hospital Clinic, 08036 Barcelona, Spain
| | - Camilo Moreno
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Doctoral Programme of Medicine and Translational Research, University of Barcelona, 08036 Barcelona, Spain
| | - Ivan Macia
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Francisco Rivas
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Carlos Déniz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Anna Muñoz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ines Serratosa
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Marta García
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Cristina Masuet-Aumatell
- Department of Preventive Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ignacio Escobar
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ricard Ramos
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Department of Thoracic Surgery, Hospital Clinic, 08036 Barcelona, Spain
- Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
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Huang CC, Tang EK, Shu CW, Chou YP, Goan YG, Tseng YC. Comparison of the Outcomes between Systematic Lymph Node Dissection and Lobe-Specific Lymph Node Dissection for Stage I Non-small Cell Lung Cancer. Diagnostics (Basel) 2023; 13:diagnostics13081399. [PMID: 37189500 DOI: 10.3390/diagnostics13081399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND This study compares the surgical and long-term outcomes, including disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS), between lobe-specific lymph node dissection (L-SND) and systematic lymph node dissection (SND) among patients with stage I non-small cell lung cancer (NSCLC). METHODS In this retrospective study, 107 patients diagnosed with clinical stage I NSCLC undergoing video-assisted thoracic surgery lobectomy (exclusion of the right middle lobe) from January 2011 to December 2018 were enrolled. The patients were assigned to the L-SND (n = 28) and SND (n = 79) groups according to the procedure performed on them. Demographics, perioperative data, and surgical and long-term oncological outcomes were collected and compared between the L-SND and SND groups. RESULTS The mean follow-duration was 60.6 months. The demographic data and surgical outcomes and long-term oncological outcomes were not significantly different between the two groups. The 5-year OS of the L-SND and SND groups was 82% and 84%, respectively. The 5-year DFS of the L-SND and SND groups was 70% and 65%, respectively. The 5-year CSS of the L-SND and SND groups was 80% and 86%, respectively. All the surgical and long-term outcomes were not statistically different between the two groups. CONCLUSION L-SND showed comparable surgical and oncologic outcomes with SND for clinical stage I NSCLC. L-SND could be a treatment choice for stage I NSCLC.
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Affiliation(s)
- Ching-Chun Huang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - En-Kuei Tang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chih-Wen Shu
- Institute of BioPharmaceutical Sciences, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yi-Ping Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Division of Trauma, Department of Emergency, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Yih-Gang Goan
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Surgery, Kaohsiung Veterans General Hospital Pingtung Branch, Pingtung 900, Taiwan
| | - Yen-Chiang Tseng
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
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Pan H, Gu Z, Tian Y, Jiang L, Zhu H, Ning J, Huang J, Luo Q. Propensity score-matched comparison of robotic- and video-assisted thoracoscopic surgery, and open lobectomy for non-small cell lung cancer patients aged 75 years or older. Front Oncol 2022; 12:1009298. [PMID: 36185241 PMCID: PMC9525021 DOI: 10.3389/fonc.2022.1009298] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/31/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Although robot-assisted thoracoscopic surgery (RATS) has been widely applied in treating non-small cell lung cancer (NSCLC), its advantages remain unclear for very old patients. The present study compared the perioperative outcomes and survival profiles among RATS, video-assisted thoracoscopic surgery (VATS), and open lobectomy (OL), aiming to access the superiority of RATS for NSCLC patients aged ≥75 years. Methods Pathological IA-IIIB NSCLC patients aged ≥75 years who underwent RATS, VATS, or OL between June 2015 and June 2021 in Shanghai Chest Hospital were included. Propensity score matching (PSM, 1:1:1 RATS versus VATS versus OL) was based on 10 key prognostic factors. The primary endpoints were perioperative outcomes, and the secondary endpoints were disease-free (DFS), overall (OS), and cancer-specific survival (CS). Results A total of 504 cases (126 RATS, 200 VATS, and 178 OL) were enrolled, and PSM led to 97 cases in each group. The results showed that RATS led to: 1) the best surgical-related outcomes including the shortest operation duration (p <0.001) and the least blood loss (p <0.001); 2) the fastest postoperative recoveries including the shortest ICU stay (p = 0.004), chest tube drainage duration (p <0.001), and postoperative stay (p <0.001), and the most overall costs (p <0.001); 3) the lowest incidence of postoperative complications (p = 0.002), especially pneumonia (p <0.001). There was no difference in the resection margins, reoperation rates, intraoperative blood transfusion, and volume of chest tube drainage among the three groups. Moreover, RATS assessed more N1 (p = 0.009) and total (p = 0.007) lymph nodes (LNs) than VATS, while the three surgical approaches dissected similar numbers of N1, N2, and total LN stations and led to a comparable incidence of postoperative nodal upstaging. Finally, the three groups possessed comparable DFS, OS, and CS rates. Further subgroup analysis found no difference in DFS or OS among the three groups, and multivariable analysis showed that the surgical approach was not independently correlated with survival profiles. Conclusion RATS possessed the superiority in achieving better perioperative outcomes over VATS and OL in very old NSCLC patients, though the three surgical approaches achieved comparable survival outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Jia Huang
- *Correspondence: Jia Huang, ; Qingquan Luo,
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