Robot-assisted thoracoscopic surgery versus thoracotomy for  c-N2 stage NSCLC: short-term outcomes of a randomized trial

Huang, Jia; Li, Chongwu; Li, Hecheng; Lv, Fanzhen; Jiang, Long; Hao, Lin; Lu, Peiji; Luo, Qingquan; Xü, Wei

doi:10.21037/tlcr.2019.11.31

Cited by 23 publications

(33 citation statements)

References 21 publications

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“…Despite respective innovations in these 2 directions, to our knowledge, the completion of RATS using a single incision has never been reported in the literature. With previous experience in both RATS and uniportal VATS (11)(12)(13)(14)(15), we report a Original Article 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 representative video case of right upper lobectomy in the treatment of a subsolid lung nodule (with final pathology of stage I adenocarcinoma) by uniportal RATS using the da Vinci Surgical System (Xi) shown as Video 1 as attached. We present the following article in accordance with the CARE reporting checklist (available at http://dx.doi.org/10.21037/ tlcr-21-207).…”

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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“…However, to the best of our knowledge, no prospective clinical trials have been conducted to assess whether RATS is comparable to thoracotomy for cancer control in locally advanced NSCLC. The short-term outcomes of the comparison have been reported previously, showing that RATS reduced blood loss, postoperative pain, and chest tube duration compared to thoracotomy (10). In this article, we present the long-term outcome of our prospective clinical trial after extending the follow-up period and recruiting a larger number of patients.…”

Section: Introductionmentioning

confidence: 79%

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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“…It has been generally accepted that the main indication for robotic-assisted pulmonary resection is the treatment of small stage I and II tumors with minimal burden of hilar nodal disease. However, several Authors assert that RATS, due to its advantages as the more accurate lymph node dissection, should really be applied to locally advanced disease, therefore extending the indication to robotic approach beyond early-stage NSCLC (17,(21)(22)(23)(24)(25).…”

Section: Review Articlementioning

confidence: 99%

“…Recently, preliminary data of a randomized controlled trial comparing RATS and open surgery for the treatment of clinical stage IIIA-N2 NSCLC have been released (25).…”

Section: Robotic Surgery For Locally Advanced Nclc: Literature Reviewmentioning

confidence: 99%

Robotic surgery for locally advanced non-small cell lung cancer

Muriana¹,

Perroni²,

Novellis³

et al. 2021

J Vis Surg

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Stage III non-small cell lung cancer (NSCLC) is a heterogeneous group of diseases including large masses, mediastinal lymph node involvement, and invasion of major mediastinal structures. Robotic surgery is a minimally invasive approach recognized as an equivalent alternative to open surgery in case of early stage NSCLC. An increasing number of studies also assert that robotics is a reasonable option for the treatment of locally advanced disease in the setting of multimodality therapy. Major advantages of the technique are increased radicality compared to video-assisted thoracic surgery (VATS), fast postoperative recovery and better compliance to adjuvant therapies compared to open. In this paper we present some technical aspects of the robotic lobectomy in locally advanced disease, we discuss different robotic approaches and review the literature of robotic treatment of lung cancer patients. To describe the technique, we use two case studies of patients affected by locally advanced NSCLC operated with robotic surgery. A patient with right upper lobe (RUL) pulmonary adenocarcinoma and single N2-station metastasis underwent robotic lobectomy following response to induction chemo-radiotherapy. A radical excision of the tumor was obtained with clear margins and no evidence of residual disease at pathologic examination. In the second case, a diagnosis of N2 lymph node metastasis (station R4) from pulmonary adenocarcinoma was made in a patient with primary occult tumor. After induction treatment, the patient underwent robotic radical mediastinal lymph node dissection with curative intent. Unexpected partial invasion of the wall of superior vena cava (SVC) was safely managed with tangential resection. Despite the problems of costs, availability, and learning curve, the Authors believe that robotic surgery has indisputable advantages to obtain a radical resection in case of locally advanced NSCLC.

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Robot-assisted thoracoscopic surgery versus thoracotomy for c-N2 stage NSCLC: short-term outcomes of a randomized trial

Cited by 23 publications

References 21 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

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

Robotic surgery for locally advanced non-small cell lung cancer

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