Long-term outcome of robotic versus video-assisted thoracic surgery for stageⅠ lung adenocarcinoma: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HU Boxiao ¹ , LIU Bo ² , XU Shiguang ² , LIU Xingchi ² , XU Wei ² , WANG Xilong ² , XUE Jialong ² , LI Xu ² , GONG Xiaokang ² ,  WANG Shumin ²

1. Graduate Training Base of General Hospital of Northern Theater Command, Dalian Medical School, Shenyang, 110016, P.R.China;
2. Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P.R.China;

Corresponding author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Da Vinci surgical system; lung adenocarcinoma; overall survival; disease free survival; propensity score matching

DOI：

10.7507/1007-4848.201910061

Video：

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Objective To compare the the effectiveness of robot-assisted thoracic surgery (RATS) with video-assisted thoracic surgery (VATS), in stageⅠ lung adenocarcinoma.Methods From January 2012 to December 2018, 291 patients were included. The patients were allocated into two groups including a RATS group with 125 patients and a VATS group with 166 patients. Two cohorts (RATS, VATS ) of clinical stageⅠ lung adenocarcinoma patients were matched by propensity score. Then there were 114 patients in each group (228 patients in total). There were 45 males and 69 females at age of 62±9 years in the RATS group; 44 males, 70 females at age of 62±8 years in the VATS group. Overall survival (OS) and disease-free survival (DFS) were assessed. Univariate and multivariate analyses were performed to identify factors associated with the outcomes.Results Compared with the VATS group, the RATS group got less blood loss (P<0.05) and postoperative drainage (P<0.05) with a statistical difference. There was no statistical difference in drainage time (P>0.05) or postoperative hospital stay (P>0.05) between the two groups. The RATS group harvested more stations and number of the lymph nodes with a statistical difference (P<0.05). There was no statistical difference in 1-year, 3-year and 5-year OS and mean survival time (P>0.05). While there was a statistical difference in DFS between the two groups (1-year DFS: 94.1% vs. 95.6%; 3-year DFS: 92.6% vs. 75.2%; 5-year DFS: 92.6% vs. 68.4%, P<0.05; mean DFS time: 78 months vs. 63 months, P<0.05) between the two groups. The univariate analysis found that the number of the lymph nodes dissection was the prognostic factor for OS, and tumor diameter, surgical approach, stations and number of the lymph nodes dissection were the prognostic factors for DFS. However, multivariate analysis found that there was no independent risk factor for OS, but the tumor diameter and surgical approach were independently associated with DFS.Conclusion There is no statistical difference in OS between the two groups, but the RATS group gets better DFS.

Citation： HU Boxiao, LIU Bo, XU Shiguang, LIU Xingchi, XU Wei, WANG Xilong, XUE Jialong, LI Xu, GONG Xiaokang, WANG Shumin. Long-term outcome of robotic versus video-assisted thoracic surgery for stageⅠ lung adenocarcinoma: A propensity score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(3): 284-289. doi: 10.7507/1007-4848.201910061 Copy

1.	Kidder GW, Montgomery CW. Oxygenation of frog gastric mucosa in vitro. Am J Physiol, 1975, 229(6): 1510-1513.
2.	Lim E, Baldwin D, Beckles M, et al. Guidelines on the radical management of patients with lung cancer. Thorax, 2010, 65(Suppl 3): i1-i27.
3.	Guerrera F, Lococo F, Evangelista A, et al. Risk of recurrence in stageⅠcarcinoma of the lung: a constitutionalism study on synergism between type of surgery and type of nodal staging. J Thorac Dis, 2019, 11(2): 564-572.
4.	Novellis P, Bottoni E, Voulaz E, et al. Robotic surgery, video-assisted thoracic surgery, and open surgery for early stage lung cancer: comparison of costs and outcomes at a single institute. J Thorac Dis, 2018, 10(2): 790-798.
5.	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.
6.	Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stage Ⅰ non-small cell lung cancer: comparison of robotic, video- assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265: 431-437.
7.	Chai T, Lin Y, Shen Z, et al. Comparison between video-assisted thoracoscopic lung cancer resection and robot-assisted lung cancer resection: Protocol for a systematic review and meta-analysis. Medicine (Baltimore), 2019, 98(11): e14790.
8.	Gharagozloo F, Margolis M, Tempesta B, et al. Robot-assisted lobectomy for early-stage lung cancer: report of 100 consecutive cases. Ann Thorac Surg, 2009, 88(2): 380-384.
9.	Kent M, Wang T, White R, et al. Open, video-assisted thoracic surgery, and robotic lobotomy: review of a national database. Ann Thor ac Burg, 2014, 97: 236-242.
10.	NCCN Clinical Practice guidelines in oncology non-small cell lung cancer guidelines. Version 3, 2019 January 18, 2019.
11.	Terra RM, Araujo PH, Lauricella LL, et al. Robotic pulmonary lobectomy for lung cancer treatment: program implementation and initial experience. J Bras Pneumol, 2016, 42(3): 185-190.
12.	Park BJ. Robotic lobectomy for non-small cell lung cancer (NSCLC): Multi-center registry study of long-term oncologic results. Ann Cardiothorac Surg, 2012, 1(1): 24-26.
13.	Lardinois D, De Leyn P, Van Schil P, et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg, 2006, 30(5): 787-792.
14.	Velez-Cubian FO, Rodriguez KL, Thau MR, et al. Efficacy of lymph node dissection during robotic-assisted lobectomy for non-small cell lung cancer: retrospective review of 159 consecutive cases. J Thorac Dis, 2016, 8(9): 2454-2463.
15.	Ramos R, Girard P, Masuet C, et al. Mediastinal lymph node dissection in early-stage non-small cell lung cancer: totally thoracoscopic vs thoracotomy. Eur J Cardiothorac Surg, 2012, 41(6): 1342-1348.
16.	Keller SM, Adak S, Wagner H, et al. Mediastinal lymph node dissection improves survival in patients with stages Ⅱ and Ⅲa non-small cell lung cancer. Eastern Cooperative Oncology Group. Ann Thorac Surg, 2000, 70(2): 358-365.
17.	Dai F, Xu S, Xu W, et al. A paired case controlled study comparing the short-term outcomes of Da Vinci rats and vats approach for non-small cell lung cancer. Zhongguo Fei Ai Za Zhi, 2018, 21(3): 206-211.
18.	Morin H, Horacio H, Narked T, et al. What is the advantage of a macroscopic lobotomy over a limited thorazine procedure for lung cancer surgery? Ann Thorac Surg, 2001, 72: 879-884.
19.	Saga M, Cato M, Saturday A, et al. A prospective trial of systematic nodal dissection for lung cancer by video-assisted thoracic surgery: can it be perfect? Ann Thorac Surg, 2002, 73: 900-904.

1. Kidder GW, Montgomery CW. Oxygenation of frog gastric mucosa in vitro. Am J Physiol, 1975, 229(6): 1510-1513.
2. Lim E, Baldwin D, Beckles M, et al. Guidelines on the radical management of patients with lung cancer. Thorax, 2010, 65(Suppl 3): i1-i27.
3. Guerrera F, Lococo F, Evangelista A, et al. Risk of recurrence in stageⅠcarcinoma of the lung: a constitutionalism study on synergism between type of surgery and type of nodal staging. J Thorac Dis, 2019, 11(2): 564-572.
4. Novellis P, Bottoni E, Voulaz E, et al. Robotic surgery, video-assisted thoracic surgery, and open surgery for early stage lung cancer: comparison of costs and outcomes at a single institute. J Thorac Dis, 2018, 10(2): 790-798.
5. 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.
6. Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stage Ⅰ non-small cell lung cancer: comparison of robotic, video- assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265: 431-437.
7. Chai T, Lin Y, Shen Z, et al. Comparison between video-assisted thoracoscopic lung cancer resection and robot-assisted lung cancer resection: Protocol for a systematic review and meta-analysis. Medicine (Baltimore), 2019, 98(11): e14790.
8. Gharagozloo F, Margolis M, Tempesta B, et al. Robot-assisted lobectomy for early-stage lung cancer: report of 100 consecutive cases. Ann Thorac Surg, 2009, 88(2): 380-384.
9. Kent M, Wang T, White R, et al. Open, video-assisted thoracic surgery, and robotic lobotomy: review of a national database. Ann Thor ac Burg, 2014, 97: 236-242.
10. NCCN Clinical Practice guidelines in oncology non-small cell lung cancer guidelines. Version 3, 2019 January 18, 2019.
11. Terra RM, Araujo PH, Lauricella LL, et al. Robotic pulmonary lobectomy for lung cancer treatment: program implementation and initial experience. J Bras Pneumol, 2016, 42(3): 185-190.
12. Park BJ. Robotic lobectomy for non-small cell lung cancer (NSCLC): Multi-center registry study of long-term oncologic results. Ann Cardiothorac Surg, 2012, 1(1): 24-26.
13. Lardinois D, De Leyn P, Van Schil P, et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg, 2006, 30(5): 787-792.
14. Velez-Cubian FO, Rodriguez KL, Thau MR, et al. Efficacy of lymph node dissection during robotic-assisted lobectomy for non-small cell lung cancer: retrospective review of 159 consecutive cases. J Thorac Dis, 2016, 8(9): 2454-2463.
15. Ramos R, Girard P, Masuet C, et al. Mediastinal lymph node dissection in early-stage non-small cell lung cancer: totally thoracoscopic vs thoracotomy. Eur J Cardiothorac Surg, 2012, 41(6): 1342-1348.
16. Keller SM, Adak S, Wagner H, et al. Mediastinal lymph node dissection improves survival in patients with stages Ⅱ and Ⅲa non-small cell lung cancer. Eastern Cooperative Oncology Group. Ann Thorac Surg, 2000, 70(2): 358-365.
17. Dai F, Xu S, Xu W, et al. A paired case controlled study comparing the short-term outcomes of Da Vinci rats and vats approach for non-small cell lung cancer. Zhongguo Fei Ai Za Zhi, 2018, 21(3): 206-211.
18. Morin H, Horacio H, Narked T, et al. What is the advantage of a macroscopic lobotomy over a limited thorazine procedure for lung cancer surgery? Ann Thorac Surg, 2001, 72: 879-884.
19. Saga M, Cato M, Saturday A, et al. A prospective trial of systematic nodal dissection for lung cancer by video-assisted thoracic surgery: can it be perfect? Ann Thorac Surg, 2002, 73: 900-904.

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Long-term outcome of robotic versus video-assisted thoracic surgery for stageⅠ lung adenocarcinoma: A propensity score matching study

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