Short- and long-term survival between robot-assisted thoracic surgery and video-assisted thoracoscopic surgery for non-small cell lung cancer: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHENG Ming ^1,2 , XU Shiguang ² , XU Wei ² , DING Renquan ² , LIU Xingchi ² , HU Boxiao ² , LIU Bo ² , LIU Dazhi ² , TENG Hong 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：

Robot-assisted thoracic surgery; video-assisted thoracoscopic surgery; lung cancer; short- and long-term survival; prognosis; cohort study

DOI：

10.7507/1007-4848.202111082

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Objective To compare the short- and long-term survival of patients with stage T1N0M0 non-small cell lung cancer (NSCLC) undergoing robot-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS). Methods The clinical data of 396 patients with stage T1N0M0 NSCLC treated with RATS or VATS in our hospital from 2012 to 2019 were retrospectively analyzed. There were 209 males and 187 females, with a mean age of 61.58±8.67 years. According to surgical procedures, they were separated into two groups: a RATS group (n=157) and a VATS group (n=239). The two groups were compared in terms of the survival and prognosis-influencing factors. Results The intraoperative blood loss and postoperative 24 h drainage volume in the RATS group were less than those in the VATS group (48±42 mL vs. 182±231 mL, P<0.001; 250±119 mL vs. 324±208 mL, P<0.001). The groups and number of dissected lymph node in the RATS group were more than those of the VATS group (5±2 groups vs. 3±2 groups, P<0.001; 17±9 vs. 11±8, P<0.001). There was no statistical difference in the postoperative 48 h drainage volume (P=0.497), postoperative intubation time (P=0.180) or hospital stay (P=0.313). The survival state and recurrence-free survival state in the VATS group were better than those in the VATS group (1-year survival rate: 98.7% vs. 94.8%, 5-year survival rate: 90.5% vs. 75.8%, 8-year survival rate: 76.9% vs. 62.1%, mean survival time: 93 months vs. 79 months, P=0.005; 1-year recurrence-free survival rate: 97.4% vs. 95.6%, 5-year recurrence-free survival rate: 94.8% vs. 77.8%, 8-year recurrence-free survival rate: 82.6% vs. 64.8%, mean recurrence-free survival time: 95 months vs. 79 months, P=0.004). Univariate analysis showed that surgical method, the groups and the number of dissected lymph nodes were the influencing factors for postoperative overall survival and recurrence-free survival. At the same time, the results of multivariate analysis showed that surgical method was a common independent factor for overall survival and recurrence-free survival.Conclusion RATS can obtain better survival in patients with T1N0M0 NSCLC, and RATS has more thorough lymph node dissection, less intraoperative blood loss and postoperative 24 h drainage volume.

Citation： CHENG Ming, XU Shiguang, XU Wei, DING Renquan, LIU Xingchi, HU Boxiao, LIU Bo, LIU Dazhi, TENG Hong, WANG Shumin. Short- and long-term survival between robot-assisted thoracic surgery and video-assisted thoracoscopic surgery for non-small cell lung cancer: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(9): 1133-1139. doi: 10.7507/1007-4848.202111082 Copy

1.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
2.	Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2): 69-90.
3.	National Lung Screening Trial Research Team, Aberle DR, Berg CD, et al. The national lung screening trial: Overview and study design. Radiology, 2011, 258(1): 243-253.
4.	许世广, 童向东, 刘博, 等. 机器人辅助胸腔镜下肺叶切除术16例报告. 中国微创外科杂志, 2013, 13(9): 806-809.
5.	李剑涛, 黄佳, 林皓, 等. 单中心连续333例机器人辅助胸腔镜肺叶切除术治疗Ⅰ期非小细胞肺癌. 中国胸心血管外科临床杂志, 2017, 24(11): 825-829.
6.	马征, 岳韦名, 高存, 等. 基于倾向性评分匹配法的机器人与胸腔镜辅助胸外科手术治疗肺癌的近期效果比较. 中华胸部外科电子杂志, 2020, 7(4): 208-213.
7.	张真发, 岳东升, 王勐, 等. 达芬奇机器人系统与胸腔镜在肺癌根治术中的近期疗效比较及经验探讨. 中国肿瘤临床, 2021, 48(10): 511-515.
8.	Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage ⅠA lung cancer. World J Surg, 2000, 24(1): 27-30.
9.	Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stage Ⅰ nonsmall cell lung cancer: Comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265(2): 431-437.
10.	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.
11.	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.
12.	Radkani P, Joshi D, Barot T, et al. Robotic video-assisted thoracoscopic lung resection for lung tumors: A community tertiary care center experience over four years. Surg Endosc, 2016, 30(2): 619-624.
13.	王述民, 汪诚风. 浅谈达芬奇机器人手术系统与电视胸腔镜系统在胸外科肺叶切除术中优劣. 临床军医杂志, 2016, 44(6): 551-555.
14.	Liang H, Liang W, Zhao L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: A meta-analysis. Ann Surg, 2018, 268(2): 254-259.
15.	Casiraghi M, Galetta D, Borri A, et al. Ten years' experience in robotic-assisted thoracic surgery for early stage lung cancer. Thorac Cardiovasc Surg, 2019, 67(7): 564-572.
16.	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.
17.	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.
18.	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.
19.	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.
20.	Zhang Y, Chen C, Hu J, et al. Early outcomes of robotic versus thoracoscopic segmentectomy for early-stage lung cancer: A multi-institutional propensity score-matched analysis. J Thorac Cardiovasc Surg, 2020, 160(5): 1363-1372.
21.	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.
22.	Jheon S, Yang HC, Cho S. Video-assisted thoracic surgery for lung cancer. Gen Thorac Cardiovasc Surg, 2012, 60(5): 255-260.
23.	郭洪拨, 喻本桐. 机器人与胸腔镜肺叶切除术在治疗早期非小细胞肺癌的安全性与疗效对比. 实用医学杂志, 2019, 35(4): 541-545.
24.	Wilson JL, Louie BE, Cerfolio RJ, et al. The prevalence of nodal upstaging during robotic lung resection in early stage non-small cell lung cancer. Ann Thorac Surg, 2014, 97(6): 1901-1906.
25.	Park BJ. Robotic lobectomy for non-small cell lung cancer: Long-term oncologic results. Thorac Surg Clin, 2014, 24(2): 157-162.
26.	Farivar AS, Cerfolio RJ, Vallières E, et al. Comparing robotic lung resection with thoracotomy and video-assisted thoracoscopic surgery cases entered into the Society of Thoracic Surgeons database. Innovations (Phila), 2014, 9(1): 10-15.

1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
2. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2): 69-90.
3. National Lung Screening Trial Research Team, Aberle DR, Berg CD, et al. The national lung screening trial: Overview and study design. Radiology, 2011, 258(1): 243-253.
4. 许世广, 童向东, 刘博, 等. 机器人辅助胸腔镜下肺叶切除术16例报告. 中国微创外科杂志, 2013, 13(9): 806-809.
5. 李剑涛, 黄佳, 林皓, 等. 单中心连续333例机器人辅助胸腔镜肺叶切除术治疗Ⅰ期非小细胞肺癌. 中国胸心血管外科临床杂志, 2017, 24(11): 825-829.
6. 马征, 岳韦名, 高存, 等. 基于倾向性评分匹配法的机器人与胸腔镜辅助胸外科手术治疗肺癌的近期效果比较. 中华胸部外科电子杂志, 2020, 7(4): 208-213.
7. 张真发, 岳东升, 王勐, 等. 达芬奇机器人系统与胸腔镜在肺癌根治术中的近期疗效比较及经验探讨. 中国肿瘤临床, 2021, 48(10): 511-515.
8. Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage ⅠA lung cancer. World J Surg, 2000, 24(1): 27-30.
9. Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stage Ⅰ nonsmall cell lung cancer: Comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265(2): 431-437.
10. 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.
11. 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.
12. Radkani P, Joshi D, Barot T, et al. Robotic video-assisted thoracoscopic lung resection for lung tumors: A community tertiary care center experience over four years. Surg Endosc, 2016, 30(2): 619-624.
13. 王述民, 汪诚风. 浅谈达芬奇机器人手术系统与电视胸腔镜系统在胸外科肺叶切除术中优劣. 临床军医杂志, 2016, 44(6): 551-555.
14. Liang H, Liang W, Zhao L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: A meta-analysis. Ann Surg, 2018, 268(2): 254-259.
15. Casiraghi M, Galetta D, Borri A, et al. Ten years' experience in robotic-assisted thoracic surgery for early stage lung cancer. Thorac Cardiovasc Surg, 2019, 67(7): 564-572.
16. 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.
17. 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.
18. 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.
19. 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.
20. Zhang Y, Chen C, Hu J, et al. Early outcomes of robotic versus thoracoscopic segmentectomy for early-stage lung cancer: A multi-institutional propensity score-matched analysis. J Thorac Cardiovasc Surg, 2020, 160(5): 1363-1372.
21. 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.
22. Jheon S, Yang HC, Cho S. Video-assisted thoracic surgery for lung cancer. Gen Thorac Cardiovasc Surg, 2012, 60(5): 255-260.
23. 郭洪拨, 喻本桐. 机器人与胸腔镜肺叶切除术在治疗早期非小细胞肺癌的安全性与疗效对比. 实用医学杂志, 2019, 35(4): 541-545.
24. Wilson JL, Louie BE, Cerfolio RJ, et al. The prevalence of nodal upstaging during robotic lung resection in early stage non-small cell lung cancer. Ann Thorac Surg, 2014, 97(6): 1901-1906.
25. Park BJ. Robotic lobectomy for non-small cell lung cancer: Long-term oncologic results. Thorac Surg Clin, 2014, 24(2): 157-162.
26. Farivar AS, Cerfolio RJ, Vallières E, et al. Comparing robotic lung resection with thoracotomy and video-assisted thoracoscopic surgery cases entered into the Society of Thoracic Surgeons database. Innovations (Phila), 2014, 9(1): 10-15.

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Short- and long-term survival between robot-assisted thoracic surgery and video-assisted thoracoscopic surgery for non-small cell lung cancer: A retrospective cohort study

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