Perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic atypical segmentectomy for early-stage non-small cell lung cancer: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DAI Fuqiang , TAO Shaolin , WU Xiaoli , WANG Xintian , MEI Longyong , DENG Bo ,  TAN Qunyou

Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, P. R. China;

Corresponding author：

TAN Qunyou, Email: tanqy001@163.com

Keywords：

Robotic-assisted thoracoscopic surgery; video-assisted thoracoscopic surgery; non-small cell lung cancer; atypical segmentectomy; perioperative results

DOI：

10.7507/1007-4848.202208010

Video：

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Objective To compare the perioperative outcomes of atypical segmentectomy between robotic-assisted thoracoscopic surgery (RATS) and conventional video-assisted thoracoscopic surgery (VATS) in early-stage non-small cell lung cancer (NSCLC). Methods The data of patients who underwent minimally invasive anatomic atypical segmentectomy in our hospital from October 2016 to December 2021 were collected. These patients were divided into a RATS group and a VATS group according to the operation method. Propensity score (PS) matching was used to select patients with close clinical baseline characteristics, and the perioperative results of the two groups were compared. Results A total of 1 048 patients were enrolled, including 320 males and 728 females, with a mean age of 53.51±11.13 years. There were 277 patients in the RATS group and 771 patients in the VATS group. After 1∶1 PS matching, 277 pairs were selected. Both groups were well balanced for age, sex, smoking history, body mass index, Charlson comorbidity index, pulmonary function, tumor size, tumor location, and histological type. All patients were R0 resection, and there were no deaths within 30 days after surgery. The RATS group had shorter operative time [85 (75, 105) min vs. 115 (95, 140) min, P<0.001] and less blood loss [50 (30, 100) mL vs. 60 (50, 100) mL, P=0.001]. There were no statistical differences between the two groups in lymph node resection, conversion to thoracotomy, thoracic drainage time, total amount of thoracic drainage or postoperative complications (P>0.05). Conclusion Both RATS and VATS atypical segmentectomies are safe and feasible for early-stage NSCLC. RATS can effectively shorten the operative time, and reduce blood loss.

Citation： DAI Fuqiang, TAO Shaolin, WU Xiaoli, WANG Xintian, MEI Longyong, DENG Bo, TAN Qunyou. Perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic atypical segmentectomy for early-stage non-small cell lung cancer: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(4): 557-563. doi: 10.7507/1007-4848.202208010 Copy

1.	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.
2.	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.
3.	Montagne F, Guisier F, Venissac N, et al. The role of surgery in lung cancer treatment: Present indications and future perspectives-state of the art. Cancers (Basel), 2021, 13(15): 3711.
4.	Cao J, Yuan P, Wang Y, et al. Survival rates after lobectomy, segmentectomy, and wedge resection for non-small cell lung cancer. Ann Thorac Surg, 2018, 105(5): 1483-1491.
5.	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.
6.	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.
7.	Handa Y, Tsutani Y, Mimae T, et al. Surgical outcomes of complex versus simple segmentectomy for stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2019, 107(4): 1032-1039.
8.	Handa Y, Tsutani Y, Mimae T, et al. Complex segmentectomy in the treatment of stage ⅠA non-small-cell lung cancer. Eur J Cardiothorac Surg, 2020, 57(1): 114-121.
9.	Huang J, Tian Y, Zhou QJ, et al. Comparison of perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic right upper lobectomy in non-small cell lung cancer. Transl Lung Cancer Res, 2021, 10(12): 4549-4557.
10.	Liu A, Zhao Y, Qiu T, et al. The long-term oncologic outcomes of robot-assisted bronchial single sleeve lobectomy for 104 consecutive patients with centrally located non-small cell lung cancer. Transl Lung Cancer Res, 2022, 11(5): 869-879.
11.	Azenha LF, Deckarm R, Minervini F, et al. Robotic vs. transsternal thymectomy: A single center experience over 10 years. J Clin Med, 2021, 10(21): 4991.
12.	侯煜铖, 章剑锋, 宋伟健, 等. 机器人辅助下复杂肺段切除术与简单肺段切除术治疗ⅠA期非小细胞肺癌的回顾性队列研究. 中国胸心血管外科临床杂志, 2022, 29(9): 1128-1132.
13.	Ettinger DS, Wood DE, Aisner DL, et al. Non-small cell lung cancer, version 3. 2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2022, 20(5): 497-530.
14.	Charlson M, Szatrowski TP, Peterson J, et al. Validation of a combined comorbidity index. J Clin Epidemiol, 1994, 47(11): 1245-1251.
15.	Koppie TM, Serio AM, Vickers AJ, et al. Age-adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer. Cancer, 2008, 112(11): 2384-2392.
16.	Chinese guidelines for diagnosis and treatment of primary lung cancer 2018 (English version). Chin J Cancer Res, 2019, 31(1): 1-28.
17.	Tsutani Y, Miyata Y, Nakayama H, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage ⅠA lung adenocarcinoma: Wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
18.	Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
19.	Echavarria MF, Cheng AM, Velez-Cubian FO, et al. Comparison of pulmonary function tests and perioperative outcomes after robotic-assisted pulmonary lobectomy vs segmentectomy. Am J Surg, 2016, 212(6): 1175-1182.
20.	Zhou D, Gao Y, Wang H, et al. Prevalence and anatomical characteristics of subsuperior segment in lung lower lobe. J Thorac Cardiovasc Surg, 2022, S0022-5223(22): 00411-1.
21.	Mohammad S. Robotic surgery. J Oral Biol Craniofac Res, 2013, 3(1): 2.
22.	Lauterbach R, Matanes E, Lowenstein L. Review of robotic surgery in gynecology—The future is here. Rambam Maimonides Med J, 2017, 8(2): e0019.
23.	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.
24.	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.
25.	Kinross JM, Mason SE, Mylonas G, et al. Next-generation robotics in gastrointestinal surgery. Nat Rev Gastroenterol Hepatol, 2020, 17(7): 430-440.
26.	Baig MZ, Razi SS, Agyabeng-Dadzie K, et al. Robotic-assisted thoracoscopic surgery demonstrates a lower rate of conversion to thoracotomy than video-assisted thoracoscopic surgery for complex lobectomies. Eur J Cardiothorac Surg, 2022, 62(3): ezac281.
27.	Zhou N, Corsini EM, Antonoff MB, et al. Robotic surgery and anatomic segmentectomy: An analysis of trends, patient selection, and outcomes. Ann Thorac Surg, 2022, 113(3): 975-983.
28.	陶绍霖, 康珀铭, 谭群友, 等. 经前侧入路达芬奇机器人辅助肺段切除术的临床分析. 中国胸心血管外科临床杂志, 2020, 27(2): 178-182.
29.	Xie B, Sun X, Qin Y, et al. Short-term outcomes of typical versus atypical lung segmentectomy by minimally invasive surgeries. Thorac Cancer, 2019, 10(9): 1812-1818.
30.	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.
31.	Kim SS, Khalpey Z, Daugherty SL, et al. Factors in the selection and management of chest tubes after pulmonary lobectomy: Results of a national survey of thoracic surgeons. Ann Thorac Surg, 2016, 101(3): 1082-1088.
32.	Attaar A, Luketich JD, Schuchert MJ, et al. Prolonged air leak after pulmonary resection increases risk of noncardiac complications, readmission, and delayed hospital discharge: A propensity score-adjusted analysis. Ann Surg, 2021, 273(1): 163-172.
33.	Nelson DB, Mehran RJ, Mitchell KG, et al. Robotic-assisted lobectomy for non-small cell lung cancer: A comprehensive institutional experience. Ann Thorac Surg, 2019, 108(2): 370-376.

1. 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.
2. 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.
3. Montagne F, Guisier F, Venissac N, et al. The role of surgery in lung cancer treatment: Present indications and future perspectives-state of the art. Cancers (Basel), 2021, 13(15): 3711.
4. Cao J, Yuan P, Wang Y, et al. Survival rates after lobectomy, segmentectomy, and wedge resection for non-small cell lung cancer. Ann Thorac Surg, 2018, 105(5): 1483-1491.
5. 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.
6. 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.
7. Handa Y, Tsutani Y, Mimae T, et al. Surgical outcomes of complex versus simple segmentectomy for stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2019, 107(4): 1032-1039.
8. Handa Y, Tsutani Y, Mimae T, et al. Complex segmentectomy in the treatment of stage ⅠA non-small-cell lung cancer. Eur J Cardiothorac Surg, 2020, 57(1): 114-121.
9. Huang J, Tian Y, Zhou QJ, et al. Comparison of perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic right upper lobectomy in non-small cell lung cancer. Transl Lung Cancer Res, 2021, 10(12): 4549-4557.
10. Liu A, Zhao Y, Qiu T, et al. The long-term oncologic outcomes of robot-assisted bronchial single sleeve lobectomy for 104 consecutive patients with centrally located non-small cell lung cancer. Transl Lung Cancer Res, 2022, 11(5): 869-879.
11. Azenha LF, Deckarm R, Minervini F, et al. Robotic vs. transsternal thymectomy: A single center experience over 10 years. J Clin Med, 2021, 10(21): 4991.
12. 侯煜铖, 章剑锋, 宋伟健, 等. 机器人辅助下复杂肺段切除术与简单肺段切除术治疗ⅠA期非小细胞肺癌的回顾性队列研究. 中国胸心血管外科临床杂志, 2022, 29(9): 1128-1132.
13. Ettinger DS, Wood DE, Aisner DL, et al. Non-small cell lung cancer, version 3. 2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2022, 20(5): 497-530.
14. Charlson M, Szatrowski TP, Peterson J, et al. Validation of a combined comorbidity index. J Clin Epidemiol, 1994, 47(11): 1245-1251.
15. Koppie TM, Serio AM, Vickers AJ, et al. Age-adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer. Cancer, 2008, 112(11): 2384-2392.
16. Chinese guidelines for diagnosis and treatment of primary lung cancer 2018 (English version). Chin J Cancer Res, 2019, 31(1): 1-28.
17. Tsutani Y, Miyata Y, Nakayama H, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage ⅠA lung adenocarcinoma: Wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
18. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
19. Echavarria MF, Cheng AM, Velez-Cubian FO, et al. Comparison of pulmonary function tests and perioperative outcomes after robotic-assisted pulmonary lobectomy vs segmentectomy. Am J Surg, 2016, 212(6): 1175-1182.
20. Zhou D, Gao Y, Wang H, et al. Prevalence and anatomical characteristics of subsuperior segment in lung lower lobe. J Thorac Cardiovasc Surg, 2022, S0022-5223(22): 00411-1.
21. Mohammad S. Robotic surgery. J Oral Biol Craniofac Res, 2013, 3(1): 2.
22. Lauterbach R, Matanes E, Lowenstein L. Review of robotic surgery in gynecology—The future is here. Rambam Maimonides Med J, 2017, 8(2): e0019.
23. 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.
24. 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.
25. Kinross JM, Mason SE, Mylonas G, et al. Next-generation robotics in gastrointestinal surgery. Nat Rev Gastroenterol Hepatol, 2020, 17(7): 430-440.
26. Baig MZ, Razi SS, Agyabeng-Dadzie K, et al. Robotic-assisted thoracoscopic surgery demonstrates a lower rate of conversion to thoracotomy than video-assisted thoracoscopic surgery for complex lobectomies. Eur J Cardiothorac Surg, 2022, 62(3): ezac281.
27. Zhou N, Corsini EM, Antonoff MB, et al. Robotic surgery and anatomic segmentectomy: An analysis of trends, patient selection, and outcomes. Ann Thorac Surg, 2022, 113(3): 975-983.
28. 陶绍霖, 康珀铭, 谭群友, 等. 经前侧入路达芬奇机器人辅助肺段切除术的临床分析. 中国胸心血管外科临床杂志, 2020, 27(2): 178-182.
29. Xie B, Sun X, Qin Y, et al. Short-term outcomes of typical versus atypical lung segmentectomy by minimally invasive surgeries. Thorac Cancer, 2019, 10(9): 1812-1818.
30. 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.
31. Kim SS, Khalpey Z, Daugherty SL, et al. Factors in the selection and management of chest tubes after pulmonary lobectomy: Results of a national survey of thoracic surgeons. Ann Thorac Surg, 2016, 101(3): 1082-1088.
32. Attaar A, Luketich JD, Schuchert MJ, et al. Prolonged air leak after pulmonary resection increases risk of noncardiac complications, readmission, and delayed hospital discharge: A propensity score-adjusted analysis. Ann Surg, 2021, 273(1): 163-172.
33. Nelson DB, Mehran RJ, Mitchell KG, et al. Robotic-assisted lobectomy for non-small cell lung cancer: A comprehensive institutional experience. Ann Thorac Surg, 2019, 108(2): 370-376.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic atypical segmentectomy for early-stage non-small cell lung cancer: A retrospective cohort study

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