Robot-assisted thoracic surgery <i>versus</i> video-assisted thoracic surgery for early-stage lung cancer: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MA Jilong ^1,2 , JIN Dacheng ^1,2 , HAN Songchen ^1,2 , CHEN Meng ^1,2 ,  GOU Yunjiu ¹

1. Department of Thoracic surgery, Gansu Provincial Hospital, Lanzhou, 730000, P.R.China;
2. Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, P.R.China;

Corresponding author：

GOU Yunjiu, Email: gouyunjiu@163.com

Keywords：

Robot; thoracoscopy; lung cancer; minimally invasive

DOI：

10.7507/1007-4848.201805002

Video：

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Objective To evaluate the curative effect of robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for early stage lung cancer patients.Methods We retrospectively analyzed the clinical data of 80 patients with radical resection of lung cancer in Gansu Provincial Hospital between January 2016 and December 2017. The patients were divided into two groups: 43 patients in a VATS group and 37 in a RATS group. There were 51 males and 29 females. Data were processed with STATA v14.0 statistical software.Results There were significant differences in the operative time, duration of hospital stay and operative costs between the two groups. In the RATS group, operative duration was longer (172.21 minutes versus 162.20 minutes, P=0.018), cost was higher (74 076.69 yuan versus 54 814.73 yuan, P<0.001), and required significantly shorter hospital stay (8.27 days versus 10.76 days, P=0.001) compared with those of the VATS group. There was no statistical difference between the two groups in terms of conversion (3 versus 0, P=0.144), blood loss during operation (61.29 ml versus 90.63 ml, P=0.213), dissected lymph node number (17.38 versus 12.63, P=0.095), drainage volume (1 406.76 ml versus 1 514.60 ml, P=0.617) and the drainage time (7.92 days versus 7.20 days, P=0.440).Conclusion In the early lung cancer patients who underwent thoracic surgery, the postoperative hospitalization time of the RATS group is shorter than that of the VATS group, and the operation time is longer than that of the VATS group. The other short-term surgical indexes are similar to those of thoracoscopic surgery. However, the robot has great advantages in the treatment of patients with difficult lymph node dissection, serious pleural adhesion and complicated anatomical relationship.

Citation： MA Jilong, JIN Dacheng, HAN Songchen, CHEN Meng, GOU Yunjiu. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for early-stage lung cancer: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(1): 48-52. doi: 10.7507/1007-4848.201805002 Copy

1.	Keenan RJ, Landreneau RJ, Maley RH Jr, et al. Segmental resection spares pulmonary function in patients with stage Ⅰ lung cancer. Ann Thorac Surg, 2004, 78(1): 228-233.
2.	Koike T, Yamato Y, Yoshiya K, et al. Intentional limited pulmonary resection for peripheral T1 N0 M0 small-sized lung cancer. J Thorac Cardiovasc Surg, 2003, 125(4): 924-928.
3.	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.
4.	Mungo B, Hooker CM, Ho JS, et al. Robotic versus thoracoscopic resection for lung cancer: early results of a new robotic program. J Laparoendosc Adv Surg Tech A, 2016, 26(4): 243-248.
5.	Grogan EL, Jones DR. VATS lobectomy is better than open thoracotomy: what is the evidence for short-term outcomes? Thorac Surg Clin, 2008, 18(3): 249-258.
6.	Park JS, Kim K, Choi MS, et al. Video-assisted thoracic surgery (VATS) lobectomy for pathologic stage Ⅰ non-small cell lung cancer: A comparative study with thoracotomy lobectomy. Korean J Thorac Cardiovasc Surg, 2011, 44(1): 32-38.
7.	Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg, 2010, 139(2): 366-378.
8.	Rueth NM, Andrade RS. Is VATS lobectomy better: perioperatively, biologically and oncologically? Ann Thorac Surg, 2010, 89(6): S2107-S2111.
9.	Swanson SJ, Herndon JE 2nd, D'Amico TA, et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802--a prospective, multi-institution feasibility study. J Clin Oncol, 2007, 25(31): 4993-4997.
10.	Whitson BA, Groth SS, Duval SJ, et al. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg, 2008, 86(6): 2008-2016.
11.	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.
12.	Park BJ, Flores RM, Rusch VW. Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results. J Thorac Cardiovasc Surg, 2006, 131(1): 54-59.
13.	Veronesi G, Galetta D, Maisonneuve P, et al. Four-arm robotic lobectomy for the treatment of early-stage lung cancer. J Thorac Cardiovasc Surg, 2010, 140(1): 19-25.
14.	Cerfolio RJ, Bryant AS, Skylizard L, et al. Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms. J Thorac Cardiovasc Surg, 2011, 142(4): 740-746.
15.	Jang HJ, Lee HS, Park SY, et al. Comparison of the early robot-assisted lobectomy experience to video-assisted thoracic surgery lobectomy for lung cancer: a single-institution case series matching study. Innovations (Phila), 2011, 6(5): 305-310.
16.	Kent M, Wang T, Whyte R, et al. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg, 2014, 97(1): 236-242.
17.	Adams RD, Bolton WD, Stephenson JE, et al. Initial multicenter community robotic lobectomy experience: comparisons to a national database. Ann Thorac Surg, 2014, 97(6): 1893-1898.
18.	Louie BE, Wilson JL, Kim S, et al. Comparison of video-assisted thoracoscopic surgery and robotic approaches for clinical stage Ⅰ and stage Ⅱ non-small cell lung cancer using the Society of Thoracic Surgeons Database. Ann Thorac Surg, 2016, 102(3): 917-924.
19.	Louie BE, Farivar AS, Aye RW, et al. Early experience with robotic lung resection results in similar operative outcomes and morbidity when compared with matched video-assisted thoracoscopic surgery cases. Ann Thorac Surg, 2012, 93(5): 1598-1604.
20.	Amer K. Thoracoscopic mediastinal lymph node dissection for lung cancer. Semin Thorac Cardiovasc Surg, 2012, 24(1): 74-78.
21.	Rinieri P, Peillon C, Salaün M, et al. Perioperative outcomes of video- and robot-assisted segmentectomies. Asian Cardiovasc Thorac Ann, 2016, 24(2): 145-151.
22.	Demir A, Ayalp K, Ozkan B, et al. Robotic and video-assisted thoracic surgery lung segmentectomy for malignant and benign lesions. Interact Cardiovasc Thorac Surg, 2015, 20(3): 304-309.
23.	Veronesi G. Robotic lobectomy and segmentectomy for lung cancer: results and operating technique. J Thorac Dis, 2015, 7: S122-S130.
24.	Kilic A, Schuchert MJ, Pettiford BL, et al. Anatomic segmentectomy for stage Ⅰ non-small cell lung cancer in the elderly. Ann Thorac Surg, 2009, 87(6): 1662-1666.
25.	Bao F, Zhang C, Yang Y, et al. Comparison of robotic and video-assisted thoracic surgery for lung cancer: a propensity-matched analysis. J Thorac Dis, 2016, 8(7): 1798-1803.
26.	Deen SA, Wilson JL, Wilshire CL, et al. Defining the cost of care for lobectomy and segmentectomy: a comparison of open, video-assisted thoracoscopic, and robotic approaches. Ann Thorac Surg, 2014, 97(3): 1000-1007.
27.	Lee BE, Korst RJ, Kletsman E, et al. Transitioning from video-assisted thoracic surgical lobectomy to robotics for lung cancer: are there outcomes advantages? J Thorac Cardiovasc Surg, 2014, 147(2): 724-729.
28.	Flores RM, Alam N. Video-assisted thoracic surgery lobectomy (VATS), open thoracotomy, and the robot for lung cancer. Ann Thorac Surg, 2008, 85(2): S710-S715.
29.	Way LW, Stewart L, Gantert W, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg, 2003, 237(4): 460-469.
30.	Kunisaki C, Hatori S, Imada T, et al. Video-assisted thoracoscopic esophagectomy with a voice-controlled robot: the AESOP system. Surg Laparosc Endosc Percutan Tech, 2004, 14(6): 323-327.
31.	Wagner AA, Varkarakis IM, Link RE, et al. Comparison of surgical performance during laparoscopic radical prostatectomy of two robotic camera holders, EndoAssist and AESOP: a pilot study. Urology, 2006, 68(1): 70-74.
32.	Veronesi G, Agoglia BG, Melfi F, et al. Experience with robotic lobectomy for lung cancer. Innovations (Phila), 2011, 6(6): 355-360.
33.	Melfi FM, Mussi A. Robotically assisted lobectomy: learning curve and complications. Thorac Surg Clin, 2008, 18(3): 289-295.
34.	Rocco G, Internullo E, Cassivi SD, et al. The variability of practice in minimally invasive thoracic surgery for pulmonary resections. Thorac Surg Clin, 2008, 18(3): 235-247.

1. Keenan RJ, Landreneau RJ, Maley RH Jr, et al. Segmental resection spares pulmonary function in patients with stage Ⅰ lung cancer. Ann Thorac Surg, 2004, 78(1): 228-233.
2. Koike T, Yamato Y, Yoshiya K, et al. Intentional limited pulmonary resection for peripheral T1 N0 M0 small-sized lung cancer. J Thorac Cardiovasc Surg, 2003, 125(4): 924-928.
3. 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.
4. Mungo B, Hooker CM, Ho JS, et al. Robotic versus thoracoscopic resection for lung cancer: early results of a new robotic program. J Laparoendosc Adv Surg Tech A, 2016, 26(4): 243-248.
5. Grogan EL, Jones DR. VATS lobectomy is better than open thoracotomy: what is the evidence for short-term outcomes? Thorac Surg Clin, 2008, 18(3): 249-258.
6. Park JS, Kim K, Choi MS, et al. Video-assisted thoracic surgery (VATS) lobectomy for pathologic stage Ⅰ non-small cell lung cancer: A comparative study with thoracotomy lobectomy. Korean J Thorac Cardiovasc Surg, 2011, 44(1): 32-38.
7. Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg, 2010, 139(2): 366-378.
8. Rueth NM, Andrade RS. Is VATS lobectomy better: perioperatively, biologically and oncologically? Ann Thorac Surg, 2010, 89(6): S2107-S2111.
9. Swanson SJ, Herndon JE 2nd, D'Amico TA, et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802--a prospective, multi-institution feasibility study. J Clin Oncol, 2007, 25(31): 4993-4997.
10. Whitson BA, Groth SS, Duval SJ, et al. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg, 2008, 86(6): 2008-2016.
11. 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.
12. Park BJ, Flores RM, Rusch VW. Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results. J Thorac Cardiovasc Surg, 2006, 131(1): 54-59.
13. Veronesi G, Galetta D, Maisonneuve P, et al. Four-arm robotic lobectomy for the treatment of early-stage lung cancer. J Thorac Cardiovasc Surg, 2010, 140(1): 19-25.
14. Cerfolio RJ, Bryant AS, Skylizard L, et al. Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms. J Thorac Cardiovasc Surg, 2011, 142(4): 740-746.
15. Jang HJ, Lee HS, Park SY, et al. Comparison of the early robot-assisted lobectomy experience to video-assisted thoracic surgery lobectomy for lung cancer: a single-institution case series matching study. Innovations (Phila), 2011, 6(5): 305-310.
16. Kent M, Wang T, Whyte R, et al. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg, 2014, 97(1): 236-242.
17. Adams RD, Bolton WD, Stephenson JE, et al. Initial multicenter community robotic lobectomy experience: comparisons to a national database. Ann Thorac Surg, 2014, 97(6): 1893-1898.
18. Louie BE, Wilson JL, Kim S, et al. Comparison of video-assisted thoracoscopic surgery and robotic approaches for clinical stage Ⅰ and stage Ⅱ non-small cell lung cancer using the Society of Thoracic Surgeons Database. Ann Thorac Surg, 2016, 102(3): 917-924.
19. Louie BE, Farivar AS, Aye RW, et al. Early experience with robotic lung resection results in similar operative outcomes and morbidity when compared with matched video-assisted thoracoscopic surgery cases. Ann Thorac Surg, 2012, 93(5): 1598-1604.
20. Amer K. Thoracoscopic mediastinal lymph node dissection for lung cancer. Semin Thorac Cardiovasc Surg, 2012, 24(1): 74-78.
21. Rinieri P, Peillon C, Salaün M, et al. Perioperative outcomes of video- and robot-assisted segmentectomies. Asian Cardiovasc Thorac Ann, 2016, 24(2): 145-151.
22. Demir A, Ayalp K, Ozkan B, et al. Robotic and video-assisted thoracic surgery lung segmentectomy for malignant and benign lesions. Interact Cardiovasc Thorac Surg, 2015, 20(3): 304-309.
23. Veronesi G. Robotic lobectomy and segmentectomy for lung cancer: results and operating technique. J Thorac Dis, 2015, 7: S122-S130.
24. Kilic A, Schuchert MJ, Pettiford BL, et al. Anatomic segmentectomy for stage Ⅰ non-small cell lung cancer in the elderly. Ann Thorac Surg, 2009, 87(6): 1662-1666.
25. Bao F, Zhang C, Yang Y, et al. Comparison of robotic and video-assisted thoracic surgery for lung cancer: a propensity-matched analysis. J Thorac Dis, 2016, 8(7): 1798-1803.
26. Deen SA, Wilson JL, Wilshire CL, et al. Defining the cost of care for lobectomy and segmentectomy: a comparison of open, video-assisted thoracoscopic, and robotic approaches. Ann Thorac Surg, 2014, 97(3): 1000-1007.
27. Lee BE, Korst RJ, Kletsman E, et al. Transitioning from video-assisted thoracic surgical lobectomy to robotics for lung cancer: are there outcomes advantages? J Thorac Cardiovasc Surg, 2014, 147(2): 724-729.
28. Flores RM, Alam N. Video-assisted thoracic surgery lobectomy (VATS), open thoracotomy, and the robot for lung cancer. Ann Thorac Surg, 2008, 85(2): S710-S715.
29. Way LW, Stewart L, Gantert W, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg, 2003, 237(4): 460-469.
30. Kunisaki C, Hatori S, Imada T, et al. Video-assisted thoracoscopic esophagectomy with a voice-controlled robot: the AESOP system. Surg Laparosc Endosc Percutan Tech, 2004, 14(6): 323-327.
31. Wagner AA, Varkarakis IM, Link RE, et al. Comparison of surgical performance during laparoscopic radical prostatectomy of two robotic camera holders, EndoAssist and AESOP: a pilot study. Urology, 2006, 68(1): 70-74.
32. Veronesi G, Agoglia BG, Melfi F, et al. Experience with robotic lobectomy for lung cancer. Innovations (Phila), 2011, 6(6): 355-360.
33. Melfi FM, Mussi A. Robotically assisted lobectomy: learning curve and complications. Thorac Surg Clin, 2008, 18(3): 289-295.
34. Rocco G, Internullo E, Cassivi SD, et al. The variability of practice in minimally invasive thoracic surgery for pulmonary resections. Thorac Surg Clin, 2008, 18(3): 235-247.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Robot-assisted thoracic surgery versus video-assisted thoracic surgery for early-stage lung cancer: A case control study

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