Effects of da Vinci robot versus thoracoscopic surgery on body trauma and lymphocyte subsets in lung cancer patients: a propensity score matching study

Abstract

Objective To assess the impact of da Vinci robot versus thoracoscopic surgery on body trauma and lymphocyte subsets in lung cancer patients. Methods Retrospective analysis of 352 patients with lung cancer treated by minimally invasive surgery completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from October 2019 to October 2022. The patients were divided into a robotic-assisted thoracic surgery(RATS) group (n = 159) and a video-assisted thoracoscopic surgery group(VATS) (n = 193) according to the surgical procedure. Propensity score matching analysis (PSM) was performed in both groups, and perioperative indicators were recorded. Levels of inflammatory markers (C-reactive protein, CRP; interleukin-6, IL-6) and lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) were measured 1 day before surgery, 1, 3 and 5 days after surgery, respectively. To compare the effects of the two surgical procedures on the trauma and lymphocyte subsets of the patient's organism. Results 138 patients in each group after PSM. The operative time, intraoperative bleeding, postoperative drainage time, and drainage flow were all lower in the RATS group than in the VATS group, with statistically significant differences (P < 0.05). The levels of CRP and IL-6 increased in both groups after surgery compared with those before surgery, and the increase was less in the RATS group than in the VATS group. Postoperative T-lymphocyte levels were lower in both groups compared with preoperative levels, and T-lymphocyte levels were significantly lower in the VATS group compared with the RATS group (P < 0.05). Conclusion Compared with thoracoscopic radical lung cancer surgery, robotic radical lung cancer surgery is clinically superior because it is less invasive, induces less inflammatory response in the body, has faster recovery, and has less suppressive effects on lymphocyte subpopulations.

Feasibility of Robot-Assisted Cytoreductive Surgery With Upper-Abdominal Peritonectomy for Pseudomyxoma Peritonei With Low Peritoneal Carcinomatosis Index: A Pilot Study

“…28 In addition, surgical trauma can cause a systemic inflammatory response, and CRP is an acute-phase response protein that correlates positively with the degree of surgical injury. 29 Our study showed that the increase in CRP was lower in the r-CRS group than that in the l-CRS group on postoperative day 2. We believe that r-CRS is less traumatic to the body through its precise operation and causes a less severe inflammatory response, which may be related to less blood loss, leading to shorter hospital stays and a faster time for patients to return to a normal life.…”

“…As intraoperative blood loss increases, there is a corresponding increase in the risk of serious morbidity and death from surgery 28 . In addition, surgical trauma can cause a systemic inflammatory response, and CRP is an acute-phase response protein that correlates positively with the degree of surgical injury 29 . Our study showed that the increase in CRP was lower in the r-CRS group than that in the l-CRS group on postoperative day 2.…”

“…This study followed the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Kishiwada Tokushukai Hospital (approval no. : [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. The primary endpoint of this study was postoperative complications greater than Grade III according to the Clavien-Dindo ver2.0 classification during the 30 days after surgery, 15 and secondary endpoints were operative time, blood loss, C-reactive protein at the second day after surgery, complete cytoreduction, and postoperative hospital stays.…”