The efficacy of da Vinci robot-assisted lobectomy versus segmentectomy for stage ⅠA non-small cell lung cancer: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Yuchi ^1,2 , XU Shiguang ² , XU Wei ² , MENG Hao ² , WANG Xilong ² , DING Renquan ² , WANG Shiqi ² , LIU Bo ² , LIU Dazhi ² , TENG Hong ² ,  WANG Shumin ²

1. Postgraduate Training Base of General Hospital of the Northern Theater Command, China Medical University, Shenyang, 110016, P. R. China;
2. Department of Thoracic Surgery, General Hospital of the Northern Theater Command, Shenyang, 110016, P. R. China;

Corresponding author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Da Vinci robot; stage ⅠA non-small cell lung cancer; segmentectomy; lobectomy; prognosis

DOI：

10.7507/1007-4848.202206059

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Objective To compare and analyze the therapeutic effects of robot-assisted lobectomy and segmentectomy for stage ⅠA non-small cell lung cancer with a diameter≤2 cm. Methods A total of 181 patients with pathologically confirmed stage ⅠA non-small cell lung cancer (diameter≤2 cm) who underwent robot-assisted lobectomy and segmentectomy in our hospital from 2018 to 2021 were included. There were 74 males and 107 females with an average age of 57.50±10.60 years. They were divided into two groups according to the surgical procedure: a segmentectomy group (85 patients) and a lobectomy group (96 patients). Results There was no statistically significant difference between the two groups in terms of clinical data such as age, gender, smoking history, basic disease, pathological type, tumour diameter, operative time, postoperative 24 h drainage volume and overall complications (P>0.05). The intraoperative blood loss (33.88±16.26 mL vs. 39.27±19.48 mL, P=0.046), groups of dissected lymph nodes (4.76±1.19 vs. 5.52±1.46, P=0.000), number of dissected lymph nodes (14.81±7.23 vs. 18.06±7.70, P=0.004) and postoperative 72 h drainage volume (561.65±225.31 mL vs. 649.84±324.34 mL, P=0.037) of patients in the segmentectomy were less than those in the lobectomy group. The chest drainage time (5.49±3.92 d vs. 7.60±4.96 d, P=0.002) and postoperative hospital stay time (7.47±4.16 d vs. 9.67±5.50 d, P=0.003) were shorter than those in the lobectomy group. There was no conversion to thoracotomy or perioperative death in the two groups. The postoperative follow-up rate was 100.0% with a longest follow-up time of 48 months. The 3-year recurrence-free survival rates of the segmentectomy group and lobectomy group were 87.7% and 92.4%, respectively (P=0.465). Conclusion The da Vinci robot-assisted lobectomy and segmentectomy are safe and feasible surgical procedures for patients with stage ⅠA non-small cell lung cancer (diameter≤2 cm), with a similar 3-year recurrence-free survival rate. The lobectomy group has more lymph nodes dissected, while the segmentectomy group is superior to the lobectomy group in terms of intraoperative blood loss, postoperative 72 h chest drainage volume, chest drainage time and postoperative hospitalization time.

Citation： WU Yuchi, XU Shiguang, XU Wei, MENG Hao, WANG Xilong, DING Renquan, WANG Shiqi, LIU Bo, LIU Dazhi, TENG Hong, WANG Shumin. The efficacy of da Vinci robot-assisted lobectomy versus segmentectomy for stage ⅠA non-small cell lung cancer: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(1): 58-64. doi: 10.7507/1007-4848.202206059 Copy

1.	Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: A secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
2.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
3.	Lancaster HL, Heuvelmans MA, Oudkerk M. Low-dose computed tomography lung cancer screening: Clinical evidence and implementation research. J Intern Med, 2022, 292(1): 68-80.
4.	Duma N, Santana-Davila R, Molina JR. Non-small cell lung cancer: Epidemiology, screening, diagnosis, and treatment. Mayo Clin Proc, 2019, 94(8): 1623-1640.
5.	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
6.	周研, 张建平, 耿仲伟, 等. 解剖性肺段切除术与肺叶切除术治疗磨玻璃结节样非小细胞肺癌的疗效分析. 局解手术学杂志, 2022, 31(3): 198-201.
7.	Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
8.	汤井双, 黄晶晶, 李志华, 等. 肺叶切除术与肺段切除术治疗直径≤2 cm浸润性肺腺癌的临床效果分析. 南京医科大学学报(自然科学版), 2022, 42(3): 387-392.
9.	Bennett WF, Smith RA. Segmental resection for bronchogenic carcinoma: A surgical alternative for the compromised patient. Ann Thorac Surg, 1979, 27(2): 169-172.
10.	Miller JI, Hatcher CR. Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function. Ann Thorac Surg, 1987, 44(4): 340-343.
11.	王俊, 赵辉. 亚肺叶切除治疗早期肺癌需要考虑的几个问题. 中国肺癌杂志, 2016, 19(6): 351-354.
12.	Kirby TJ, Mack MJ, Landreneau RJ, et al. Initial experience with video-assisted thoracoscopic lobectomy. Ann Thorac Surg, 1993, 56(6): 1248-1252.
13.	Walker WS, Carnochan FM, Pugh GC. Thoracoscopic pulmonary lobectomy. Early operative experience and preliminary clinical results. J Thorac Cardiovasc Surg, 1993, 106: 1111-1117.
14.	许世广, 王述民. 浅谈达芬奇机器人手术500例体会. 中国胸心血管外科临床杂志, 2015, 22(10): 895-900.
15.	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.
16.	柴新春, 许世广, 刘博, 等. ⅠA期非小细胞肺癌行达芬奇机器人和电视胸腔镜肺段切除术近期疗效对比分析. 中华胸心血管外科杂志, 2021, 37(11): 644-648.
17.	齐凯, 曾惟标, 魏益平, 等. 胸腔镜下肺段切除术与肺叶切除术治疗Ⅰ期非小细胞肺癌远期疗效的Meta分析. 实用临床医学, 2021, 22(5): 18-23, 30.
18.	黄文海, 林志潮, 谢泽华, 等. 胸腔镜肺叶切除术与肺段切除术治疗早期肺癌的疗效差异研究. 中国现代医生, 2021, 59(16): 72-74, 78.
19.	燕晓光, 张军, 罗卫民, 等. 微创肺叶切除术与微创肺段切除术治疗早期非小细胞肺癌的临床疗效比较. 中国医学工程, 2022, 30(7): 69-73.
20.	纳迪尔·伊敏, 陆周一, 白赟彪, 等. 基于倾向性评分匹配法探讨胸腔镜下解剖性肺段切除与肺叶切除对术后患者肺功能影响. 中华胸心血管外科杂志, 2022, 38(1): 1-4.
21.	李小军, 张璞, 薛锋. 胸腔镜微创外科与传统手术治疗原发性纵隔肿瘤的临床疗效及安全性比较. 贵州医药, 2021, 45(3): 372-373.
22.	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.
23.	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.
24.	Wei S, Chen M, Chen N, et al. Feasibility and safety of robot-assisted thoracic surgery for lung lobectomy in patients with non-small cell lung cancer: A systematic review and meta-analysis. World J Surg Oncol, 2017, 15(1): 98.
25.	许世广, 刘星池, 王希龙, 等. 应用达芬奇机器人手术系统肺切除技术总结. 中华胸部外科电子杂志, 2016, 3(2): 77-82.
26.	王述民. 机器人手术十年体会. 中华胸部外科电子杂志, 2021, 8(1): 1-5.
27.	Nomori H, Yamazaki I, Machida Y, et al. Lobectomy versus segmentectomy: A propensity score-matched comparison of postoperative complications, pulmonary function and prognosis. Interact Cardiovasc Thorac Surg, 2022, 34(1): 57-65.
28.	Carr SR, Schuchert MJ, Pennathur A, et al. Impact of tumor size on outcomes after anatomic lung resection for stage ⅠA non-small cell lung cancer based on the current staging system. J Thorac Cardiovasc Surg, 2012, 143(2): 390-397.
29.	Moon MH, Moon YK, Moon SW. Segmentectomy versus lobectomy in early non-small cell lung cancer of 2 cm or less in size: A population-based study. Respirology, 2018, 23(7): 695-703.
30.	Tsutani Y, Miyata Y, Nakayama H, et al. Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage ⅠA lung adenocarcinoma: Propensity score-matched analysis in a multicenter study. J Thorac Cardiovasc Surg, 2013, 146(2): 358-364.
31.	张强. 胸腔镜下肺段切除与肺叶切除治疗早期非小细胞肺癌的疗效及远期预后分析. 福建医科大学, 2021.
32.	刘文科, 董思远, 别星星, 等. Ⅰ期非小细胞肺癌肺叶切除术及肺叶部分切除术术后生存的Meta分析. 现代肿瘤医学, 2018, 26(14): 2191-2198.
33.	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.
34.	Casiraghi M, Sedda G, Diotti C, et al. Postoperative outcomes of robotic-assisted lobectomy in obese patients with non-small-cell lung cancer. Interact Cardiovasc Thorac Surg, 2020, 30(3): 359-365.
35.	徐惟, 许世广, 李博, 等. 机器人肺癌根治术围手术期并发症及预防策略分析. 中华胸心血管外科杂志, 2020, 36(9): 539-542.
36.	杨子林, 徐惟, 许世广, 等. 机器人肺癌术后胸腔引流时间影响因素分析及应对策略. 中国胸心血管外科临床杂志, 2021, 28(5): 524-528.

1. Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: A secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
2. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
3. Lancaster HL, Heuvelmans MA, Oudkerk M. Low-dose computed tomography lung cancer screening: Clinical evidence and implementation research. J Intern Med, 2022, 292(1): 68-80.
4. Duma N, Santana-Davila R, Molina JR. Non-small cell lung cancer: Epidemiology, screening, diagnosis, and treatment. Mayo Clin Proc, 2019, 94(8): 1623-1640.
5. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
6. 周研, 张建平, 耿仲伟, 等. 解剖性肺段切除术与肺叶切除术治疗磨玻璃结节样非小细胞肺癌的疗效分析. 局解手术学杂志, 2022, 31(3): 198-201.
7. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
8. 汤井双, 黄晶晶, 李志华, 等. 肺叶切除术与肺段切除术治疗直径≤2 cm浸润性肺腺癌的临床效果分析. 南京医科大学学报(自然科学版), 2022, 42(3): 387-392.
9. Bennett WF, Smith RA. Segmental resection for bronchogenic carcinoma: A surgical alternative for the compromised patient. Ann Thorac Surg, 1979, 27(2): 169-172.
10. Miller JI, Hatcher CR. Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function. Ann Thorac Surg, 1987, 44(4): 340-343.
11. 王俊, 赵辉. 亚肺叶切除治疗早期肺癌需要考虑的几个问题. 中国肺癌杂志, 2016, 19(6): 351-354.
12. Kirby TJ, Mack MJ, Landreneau RJ, et al. Initial experience with video-assisted thoracoscopic lobectomy. Ann Thorac Surg, 1993, 56(6): 1248-1252.
13. Walker WS, Carnochan FM, Pugh GC. Thoracoscopic pulmonary lobectomy. Early operative experience and preliminary clinical results. J Thorac Cardiovasc Surg, 1993, 106: 1111-1117.
14. 许世广, 王述民. 浅谈达芬奇机器人手术500例体会. 中国胸心血管外科临床杂志, 2015, 22(10): 895-900.
15. 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.
16. 柴新春, 许世广, 刘博, 等. ⅠA期非小细胞肺癌行达芬奇机器人和电视胸腔镜肺段切除术近期疗效对比分析. 中华胸心血管外科杂志, 2021, 37(11): 644-648.
17. 齐凯, 曾惟标, 魏益平, 等. 胸腔镜下肺段切除术与肺叶切除术治疗Ⅰ期非小细胞肺癌远期疗效的Meta分析. 实用临床医学, 2021, 22(5): 18-23, 30.
18. 黄文海, 林志潮, 谢泽华, 等. 胸腔镜肺叶切除术与肺段切除术治疗早期肺癌的疗效差异研究. 中国现代医生, 2021, 59(16): 72-74, 78.
19. 燕晓光, 张军, 罗卫民, 等. 微创肺叶切除术与微创肺段切除术治疗早期非小细胞肺癌的临床疗效比较. 中国医学工程, 2022, 30(7): 69-73.
20. 纳迪尔·伊敏, 陆周一, 白赟彪, 等. 基于倾向性评分匹配法探讨胸腔镜下解剖性肺段切除与肺叶切除对术后患者肺功能影响. 中华胸心血管外科杂志, 2022, 38(1): 1-4.
21. 李小军, 张璞, 薛锋. 胸腔镜微创外科与传统手术治疗原发性纵隔肿瘤的临床疗效及安全性比较. 贵州医药, 2021, 45(3): 372-373.
22. 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.
23. 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.
24. Wei S, Chen M, Chen N, et al. Feasibility and safety of robot-assisted thoracic surgery for lung lobectomy in patients with non-small cell lung cancer: A systematic review and meta-analysis. World J Surg Oncol, 2017, 15(1): 98.
25. 许世广, 刘星池, 王希龙, 等. 应用达芬奇机器人手术系统肺切除技术总结. 中华胸部外科电子杂志, 2016, 3(2): 77-82.
26. 王述民. 机器人手术十年体会. 中华胸部外科电子杂志, 2021, 8(1): 1-5.
27. Nomori H, Yamazaki I, Machida Y, et al. Lobectomy versus segmentectomy: A propensity score-matched comparison of postoperative complications, pulmonary function and prognosis. Interact Cardiovasc Thorac Surg, 2022, 34(1): 57-65.
28. Carr SR, Schuchert MJ, Pennathur A, et al. Impact of tumor size on outcomes after anatomic lung resection for stage ⅠA non-small cell lung cancer based on the current staging system. J Thorac Cardiovasc Surg, 2012, 143(2): 390-397.
29. Moon MH, Moon YK, Moon SW. Segmentectomy versus lobectomy in early non-small cell lung cancer of 2 cm or less in size: A population-based study. Respirology, 2018, 23(7): 695-703.
30. Tsutani Y, Miyata Y, Nakayama H, et al. Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage ⅠA lung adenocarcinoma: Propensity score-matched analysis in a multicenter study. J Thorac Cardiovasc Surg, 2013, 146(2): 358-364.
31. 张强. 胸腔镜下肺段切除与肺叶切除治疗早期非小细胞肺癌的疗效及远期预后分析. 福建医科大学, 2021.
32. 刘文科, 董思远, 别星星, 等. Ⅰ期非小细胞肺癌肺叶切除术及肺叶部分切除术术后生存的Meta分析. 现代肿瘤医学, 2018, 26(14): 2191-2198.
33. 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.
34. Casiraghi M, Sedda G, Diotti C, et al. Postoperative outcomes of robotic-assisted lobectomy in obese patients with non-small-cell lung cancer. Interact Cardiovasc Thorac Surg, 2020, 30(3): 359-365.
35. 徐惟, 许世广, 李博, 等. 机器人肺癌根治术围手术期并发症及预防策略分析. 中华胸心血管外科杂志, 2020, 36(9): 539-542.
36. 杨子林, 徐惟, 许世广, 等. 机器人肺癌术后胸腔引流时间影响因素分析及应对策略. 中国胸心血管外科临床杂志, 2021, 28(5): 524-528.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The efficacy of da Vinci robot-assisted lobectomy versus segmentectomy for stage ⅠA non-small cell lung cancer: A retrospective cohort study

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