Perioperative outcomes of robot‐assisted vs video‐assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta‐analysis

Hu, Junjie; Chen, Yan; Dai, Jie; Zhu, Xinsheng; González-Rivas, Diego; Jiang, Gening; Li, Hua; Zhang, Peng

doi:10.1002/rcs.2123

Cited by 21 publications

(26 citation statements)

References 80 publications

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“…As a quickly evolving, next-generation minimally invasive technique, RATS has increasingly grown in popularity in recent years. The robotic platform has some technical advantages over VATS, including a three-dimensional operative view, intuitive use of the robotic hands, and increased instrument flexibility; therefore, it has the potential to surpass VATS in the handling of more complex cases and may facilitate lymph node dissection (3)(4)(5)(6). Currently, RATS requires 3 or 4 ports and 1 or 2 assistive incisions.…”

Section: Introductionmentioning

confidence: 99%

A uniportal right upper lobectomy by three-arm robotic-assisted thoracoscopic surgery using the da Vinci (Xi) Surgical System in the treatment of early-stage lung cancer

Yang

Song

Huang

et al. 2021

Transl Lung Cancer Res

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Minimally invasive techniques, typified by video-assisted thoracoscopic surgery, are widely practiced in the treatment of thoracic diseases all around the world, and video-assisted thoracoscopic surgery has been recognized as a standard treatment method for early staged lung cancer. Among them, roboticassisted thoracoscopic surgery, which has the advantages of providing a three-dimensional view and better maneuverability, has emerged as a next-generation technique in the field of minimally invasive surgery and is also gaining its popularity with the idea of Enhanced Recovery After Surgery deeply rooted in patients' minds. Up to now, robotic-assisted thoracoscopic surgery usually requires 3 or 4 ports with 1 or 2 additional access incisions. Meanwhile, traditional video-assisted thoracoscopic surgery can now be completed with uniportal method, with less postoperative pain and higher patient satisfaction with respect to the number of incisions in comparison with the multi-port technique. To inform the integration of these new minimally invasive techniques, here, we present a case in which uniportal right upper lobectomy was performed using the 4 th generation da Vinci Robotic Surgical System (Xi). With continuous innovation in robotic minimally invasive techniques and improvements in surgical skills, we believe more patients will benefit from roboticassisted thoracoscopic surgery with single port in the near future.

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Section: Introductionmentioning

confidence: 99%

A uniportal right upper lobectomy by three-arm robotic-assisted thoracoscopic surgery using the da Vinci (Xi) Surgical System in the treatment of early-stage lung cancer

Yang

Song

Huang

et al. 2021

Transl Lung Cancer Res

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“…For example, in an analysis of patients with rectal cancer investigators reviewed claims data from 2005 through 2017, reporting decreased LOS for robotic surgery as compared to open surgery [ 13 ]. In contrast, although the lung cancer literature reveals reductions in hospital LOS for minimally invasive approaches as compared to open lung surgery [ 8 ], analyses of robotic lung surgery have not demonstrated appreciable gains in LOS as compared to VATS [ 2 , 15 ]. In kidney cancer, reduced LOS has been demonstrated for MIS vs open modalities, however the literature comparing robotic and laparoscopic modalities has demonstrated inconsistent results [ 16 – 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, data from the Norwegian Registry for Gastrointestinal Surgery and from the Norwegian Colorectal Cancer Registry also revealed lower conversion rates with robotic-assisted rectal resections compared with conventional laparoscopic resections [ 20 ]. In the same manner, meta-analyses of patients with lung cancer have similarly identified lower conversion to open surgery for patients who underwent robotic surgery as compared to video-assisted surgery [ 15 , 21 ]. Although not all studies have demonstrated fewer conversions with robotic surgery [ 7 ], our data convincingly demonstrate significant reductions in conversions in all studied procedures except for nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

Healthcare Resource Utilization After Surgical Treatment of Cancer: Value of Minimally Invasive Surgery

et al. 2022

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Background As the US healthcare system moves towards value-based care, hospitals have increased efforts to improve quality and reduce unnecessary resource use. Surgery is one of the most resource-intensive areas of healthcare and we aim to compare health resource utilization between open and minimally invasive cancer procedures. Methods We retrospectively analyzed cancer patients who underwent colon resection, rectal resection, lobectomy, or radical nephrectomy within the Premier hospital database between 2014 and 2019. Study outcomes included length of stay (LOS), discharge status, reoperation, and 30-day readmission. The open surgical approach was compared to minimally invasive approach (MIS), with subgroup analysis of laparoscopic/video-assisted thoracoscopic surgery (LAP/VATS) and robotic (RS) approaches, using inverse probability of treatment weighting. Results MIS patients had shorter LOS compared to open approach: − 1.87 days for lobectomy, − 1.34 days for colon resection, − 0.47 days for rectal resection, and − 1.21 days for radical nephrectomy (all p < .001). All MIS procedures except for rectal resection are associated with higher discharge to home rates and lower reoperation and readmission rates. Within MIS, robotic approach was further associated with shorter LOS than LAP/VATS: − 0.13 days for lobectomy, − 0.28 days for colon resection, − 0.67 days for rectal resection, and − 0.33 days for radical nephrectomy (all p < .05) and with equivalent readmission rates. Conclusion Our data demonstrate a significant shorter LOS, higher discharge to home rate, and lower rates of reoperation and readmission for MIS as compared to open procedures in patients with lung, kidney, and colorectal cancer. Patients who underwent robotic procedures had further reductions in LOS compare to laparoscopic/video-assisted thoracoscopic approach, while the reductions in LOS did not lead to increased rates of readmission.

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“…The application of RATS is becoming increasingly common in several surgical disciplines (such as urology, gynecology, and cardiac surgery) owing to its optimal operability and minimal invasiveness (12)(13)(14)(15). Previous studies have indicated that RATS reduces intraoperative bleeding, chest tube drainage, and hospitalization stay compared to thoracotomy in early-stage NSCLC patients (15)(16)(17). RATS has also been shown to reduce postoperative pain compared to thoracotomy in stage I−IIIA NSCLC patients (18).…”

Section: Discussionmentioning

confidence: 99%

“…RATS has also been shown to reduce postoperative pain compared to thoracotomy in stage I−IIIA NSCLC patients (18). Regarding safety, postoperative complications of RATS have been demonstrated to be similar those of thoracotomy in early-stage NSCLC patients (17,19). However, RATS may increase the overall cost and incur a large economic burden on patients (18,20,21).…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted thoracic surgery reduces perioperative complications and achieves a similar long-term survival profile as posterolateral thoracotomy in clinical N2 stage non-small cell lung cancer patients: a multicenter, randomized, controlled trial

Huang¹,

Tian²,

Li³

et al. 2021

Transl Lung Cancer Res

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Background: Our previous study demonstrated the safety and short-term efficacy of robotic-assisted thoracic surgery (RATS) in clinical N2 (c-N2) stage non-small cell lung cancer (NSCLC) patients. From this, the present study was devised, in which the follow-up time and sample size were both extended to explore the long-term efficacy and potential benefit in survival of RATS compared with lobectomy in c-N2 stage NSCLC patients.Methods: Patients with c-N2 NSCLS were randomly assigned in a 1:1 ratio to accept operation through thoracotomy or RATS. The da Vinci Surgical System (Si/Xi) was applied in the RATS group, while conventional lobectomy with a rib-spreading incision was applied in the posterolateral thoracotomy group.Primary endpoint was defined as disease free survival and overall survival (OS) of all recruited patients.Results: Compared with posterolateral thoracotomy group (N=72), the RATS group (N=76) had a reduced blood loss (P<0.001), decreased drainage duration (P=0.002), and decreased postoperative pain visual analog score (all P<0.001), but increased overall cost (P<0.001). Meanwhile, no difference in the other postoperative complications (such as air leakage, subcutaneous emphysema, atrial fibrillation etc.) was found between the RATS group and the posterolateral thoracotomy group (all P>0.05). Regarding long-term outcome, no difference in disease-free survival (DFS; P=0.925) or OS (P=0.853) was observed between the RATS group and posterolateral thoracotomy group. Subgroup analyses and multivariable Cox regression analyses also found no difference in DFS or OS between the RATS group and posterolateral thoracotomy groups.Conclusions: RATS reduced intraoperative bleeding, drainage duration, postoperative pain, and achieved similar long-term survival outcomes compared with posterolateral thoracotomy in c-N2 stage NSCLC patients.

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Perioperative outcomes of robot‐assisted vs video‐assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta‐analysis

Cited by 21 publications

References 80 publications

A uniportal right upper lobectomy by three-arm robotic-assisted thoracoscopic surgery using the da Vinci (Xi) Surgical System in the treatment of early-stage lung cancer

A uniportal right upper lobectomy by three-arm robotic-assisted thoracoscopic surgery using the da Vinci (Xi) Surgical System in the treatment of early-stage lung cancer

Healthcare Resource Utilization After Surgical Treatment of Cancer: Value of Minimally Invasive Surgery

Robotic-assisted thoracic surgery reduces perioperative complications and achieves a similar long-term survival profile as posterolateral thoracotomy in clinical N2 stage non-small cell lung cancer patients: a multicenter, randomized, controlled trial

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