Comparison of perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic right upper lobectomy in non-small cell lung cancer

Huang, Jia; Tian, Yu; Zhou, Quan; Ning, Junwei; Lu, Peiji; Li, Jiantao; Hao, Lin; Chen, Tianxiang; Yang, Yunhai; Kim, Min P.; Merritt, Robert E.; Ghisalberti, Marco; Jiang, Long; Luo, Qingquan

doi:10.21037/tlcr-21-960

Cited by 19 publications

(35 citation statements)

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“…The dissection of LNs is of key importance in the surgical resection of NSCLC. Similar to the results reported by previous studies that enrolled younger patients, the total number of LNs harvested by RATS was 12.01 ± 5.55 in our study, suggesting that LNs dissection using robot-assisted surgical systems may not be significantly affected by growth in ages (11,15,30,31 Although various kinds of preoperative LNs assessment approaches have been prompted, there is still a 3%-15% of rate occult N2 disease identified at the pathological stage (11, 32, 37-40). However, the occult N2 disease could lead to a poor prognosis and therefore influence the survival profiles in our study.…”

Section: Discussionsupporting

confidence: 91%

“…RATS, VATS, and OL were conducted according to the procedures described previously (6,14,15). Briefly, patients received general anesthesia with double-lumen tracheal intubation and contralateral single-lung ventilation and underwent radical pulmonary lobectomy combined with systemic pulmonary and mediastinal LNs dissection.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…frequently experience postoperative complications, slow recoveries, and poor outcomes than younger individuals, which has promoted critical challenges to surgical resections(15, 25). Although the feasibility and oncological efficacy of RATS in younger NSCLC patients have been widely investigated and well established, the research on RATS for very old NSCLC patients is still limited.…”

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confidence: 99%

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Propensity score-matched comparison of robotic- and video-assisted thoracoscopic surgery, and open lobectomy for non-small cell lung cancer patients aged 75 years or older

et al. 2022

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Introduction: Although robot-assisted thoracoscopic surgery (RATS) has been widely applied in treating non-small cell lung cancer (NSCLC), its advantages remain unclear for very old patients. The present study compared the perioperative outcomes and survival profiles among RATS, video-assisted thoracoscopic surgery (VATS), and open lobectomy (OL), aiming to access the superiority of RATS for NSCLC patients aged ≥75 years.Methods: Pathological IA-IIIB NSCLC patients aged ≥75 years who underwent RATS, VATS, or OL between June 2015 and June 2021 in Shanghai Chest Hospital were included. Propensity score matching (PSM, 1:1:1 RATS versus VATS versus OL) was based on 10 key prognostic factors. The primary endpoints were perioperative outcomes, and the secondary endpoints were disease-free (DFS), overall (OS), and cancer-specific survival (CS).Results: A total of 504 cases (126 RATS, 200 VATS, and 178 OL) were enrolled, and PSM led to 97 cases in each group. The results showed that RATS led to: 1) the best surgical-related outcomes including the shortest operation duration (p <0.001) and the least blood loss (p <0.001); 2) the fastest postoperative recoveries including the shortest ICU stay (p = 0.004), chest tube drainage duration (p <0.001), and postoperative stay (p <0.001), and the most overall costs (p <0.001); 3) the lowest incidence of postoperative complications (p = 0.002), especially pneumonia (p <0.001). There was no difference in the resection margins, reoperation rates, intraoperative blood transfusion, and volume of chest tube drainage among the three groups. Moreover, RATS assessed more N1 (p = 0.009) and total (p = 0.007) lymph nodes (LNs) than VATS, while the three surgical approaches dissected similar numbers of N1, N2, and total LN stations and led to a comparable incidence of postoperative nodal upstaging. Finally, the three groups possessed comparable DFS, OS, and CS rates. Further subgroup analysis found no difference in DFS or OS among the Frontiers in Oncology frontiersin.org 01

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Section: Discussionsupporting

confidence: 91%

Section: Surgical Proceduresmentioning

confidence: 99%

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confidence: 99%

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Propensity score-matched comparison of robotic- and video-assisted thoracoscopic surgery, and open lobectomy for non-small cell lung cancer patients aged 75 years or older

et al. 2022

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“…The best surgical option for resectable stage II and above NSCLC is still controversial, and studies generally agree that thoracotomy can achieve excellent long-term postoperative outcomes, especially in lymph node dissection (13,19). It has been reported recently that RATS has the same long-term outcomes as thoracotomy and VATS, as well as better short-term results (20)(21)(22)(23)(24). The ROMAN study (7) and RVlob Trial (25), which is a perioperative randomized multicentric clinical trial for stage I-II NSCLC, both confirmed that robotic methods can improve lymph node staging and obtain a higher lymph node yield.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the perioperative outcomes between robotic-assisted thoracic surgery and video-assisted thoracic surgery in non-small cell lung cancer patients with different body mass index ranges

Qu¹,

Li²,

Ma³

et al. 2022

Transl Lung Cancer Res

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Background: Non-small cell lung cancer (NSCLC) is the most common malignancy and one of the most common causes of cancer-related death worldwide. Robotic-assisted thoracic surgery (RATS) has gradually become a prevalent surgical method for patients with NSCLC. Previous studies have found that body mass index (BMI) is associated with postoperative outcomes. This study aimed to investigate the effectiveness of RATS compared to video-assisted thoracic surgery (VATS) in the treatment of NSCLC with different BMI, in terms of perioperative outcomes. Methods:The baseline and perioperative data, including BMI, of 849 NSCLC patients who underwent minimally invasive anatomic lung resections from August 2020 to April 2021 were retrospectively collected and analyzed. Propensity score matching analysis was applied to minimize potential bias between the two groups (VATS and RATS), and the perioperative outcomes were compared. Subgroup analysis was subsequently performed.Results: Compared to VATS, RATS had more lymph nodes dissected {9 [inter-quartile range (IQR), 6-12] vs. 7 (IQR, 6-10), P<0.001}, a lower estimated bleeding volume [40 (IQR, 30-50) vs. 50 (IQR, 40-60) mL, P<0.001], and other better postoperative outcomes, but a higher cost of hospitalization [¥83,626 (IQR, 77,686) vs. ¥75,804 (IQR, 66,693), P<0.001]. Multivariable logistic regression analysis indicated that RATS (P=0.027) and increasing BMI (P=0.030) were associated with a statistically significant reduction in the risk of postoperative complications. Subgroup analysis indicated that the advantages of RATS may be more obvious in patients with a BMI of 24-28 kg/m 2 , in which the RATS group had more lymph nodes dissected [9 (IQR, 6-12) vs. 7 (IQR, 5-10), P<0.001] and a decreased risk of total postoperative complications [odds ratio (OR), 0.443; 95% confidence interval (CI), 0.212-0.924; P=0.030] compared to the VATS group.Conclusions: Both, RATS and VATS can be safely applied for patients with NSCLC. Perioperative outcome parameters indicate advantages for RATS, however at a higher cost of hospitalization. The advantages of RATS might be more obvious in patients with a BMI of 24-28 kg/m 2 .

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“…Huang et al discovered that for patients with cN2 non-small cell lung cancer (NSCLC) RATS has similar long time survival to thoracotomy ( 12 ). Compared to VATS, RATS is able to dissect lymph nodes more finely and has a relatively shorter operation time ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

A retrospective comparative cohort study on the efficacy and safety of bi-port robotic-assisted lobectomy and multi-port robotic-assisted lobectomy

Huang¹,

Tian²,

Jiang³

et al. 2022

J Thorac Dis

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Background The pursuit of less surgical incisions brings better postoperative experience of patients and earns extensive popularity recently. As the update to the da Vinci robotic surgical system has reduced the size of the robotic arm, a new surgical method with fewer ports has become feasible. We performed 20 cases of robotic surgery with only 2 ports and compared the efficacy and safety between bi-port robotic-assisted lobectomy and multi-port robotic-assisted lobectomy. Methods To compare the efficacy and safety of the different surgery strategies, we retrospectively reviewed 20 cases of bi-port robotic-assisted thoracic surgery (RATS) and 40 cases of multi-port RATS which were performed at the Shanghai Chest Hospital Between February 2021 and May 2021. The baseline characteristics and their perioperative data were collected and analyzed. Chest tube drainage, chest tube removal time, lymphadenectomy outcomes, operation duration were collected to compare the efficacy of the two groups and blood loss, perioperative complications were recorded to value the safety. Results A total of 60 surgeries in the 2 groups were successfully completed. The baseline characteristics in terms of sex, age, health statues were comparable (P≥0.05). The maximum diameter of the tumor in the bi-port surgery group was 0.5–3.6 cm (2.0±1.0) vs. 0.5–4.0 cm (1.9±0.9) cm in the control group. No significant difference was discovered in terms of tumor location, tumor maximum diameter, tumor histology. The intraoperative blood loss was 60.0±20.5 mL and the average operation time was 95.6±21.4 min in the bi-port surgery group compared to 65.0±30.4 mL and 101.4±25.0 min in the control group. An average of 6.0±1.4 lymph nodes were collected in the bi-port surgery group with a mean diameter of 1.2±0.4 cm, and in the control group, an average of 6.1±1.6 lymph nodes were collected with a mean diameter was 1.2±0.5 cm. The average time of chest drainage was 4.3±1 vs. 5.1±1.3 days in the bi-port surgery group and control group. No statistical significance was found between the two groups (P>0.05). Conclusions Compared to multi-port RATS, Bi-port robotic-assisted lobectomy was safe and showed promising efficacy in patients with early staged operable lung cancer.

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Comparison of perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic right upper lobectomy in non-small cell lung cancer

Cited by 19 publications

References 20 publications

Propensity score-matched comparison of robotic- and video-assisted thoracoscopic surgery, and open lobectomy for non-small cell lung cancer patients aged 75 years or older

Propensity score-matched comparison of robotic- and video-assisted thoracoscopic surgery, and open lobectomy for non-small cell lung cancer patients aged 75 years or older

Comparison of the perioperative outcomes between robotic-assisted thoracic surgery and video-assisted thoracic surgery in non-small cell lung cancer patients with different body mass index ranges

A retrospective comparative cohort study on the efficacy and safety of bi-port robotic-assisted lobectomy and multi-port robotic-assisted lobectomy

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