Ⅰ期非小细胞肺癌达芬奇机器人手术的疗效分析

Survival Analysis of Stage Ⅰ Non-small Cell Lung Cancer Patients Treated with Da Vinci Robot-assisted Thoracic Surgery

背景与目的达芬奇机器人手术系统在胸外科的应用日益广泛,本研究旨在探讨经达芬奇机器人手术治疗I期非小细胞肺癌(non-small cell lung cancer, NSCLC)患者的疗效。方法回顾2012年1月-2017年12月于我科行手术治疗的Ⅰ期NSCLC患者347例,依据手术方式分为机器人(robot-assisted thoracic surgery, RATS)组134例及腔镜(videoassisted thoracic surgery, VATS)组213例。比较两组患者围术期一般指标(术中出血量、术后引流量、术后带管时间、术后住院时间、淋巴结清扫状况),分析患者生存状况(overall survival, OS)、无进展生存状况(disease free survival, DFS)及相关影响因子。结果机器人组与腔镜组术中出血量[(49±39) mL vs (202±239) mL]、术后引流量[Day 1:(248±123)mL vs (350±213) mL; Day 2:(288±189) mL vs (338±189) mL]比较,机器人组均少于腔镜组(P<0.05);术后带管时间[(10±5) d vs (11±8) d]及住院时间[(13±6) d vs (14±9) d]两组患者无明显差异(P>0.05)。机器人组与腔镜组的淋巴结清扫组数[(5±2)组vs (4±2)组]及淋巴清扫数量[(18±9)枚vs(11±8)枚]比较,机器人组均优于腔镜组(P<0.05)。机器人组与腔镜组生存状况比较[1年生存率:97.3%vs 96%、3年生存率:89.8%vs 83.1%、5年生存率:87.5%vs 70.3%,平均生存时间(month):61 vs 59],两组无统计学差异(P>0.05)。无进展生存状况:机器人组与腔镜组比较[1年无进展生存率:93.7%vs 91.3%、3年无进展生存率:87.7%vs 68.4%、5年无进展生存率:87.7%vs 52.5%,平均无进展生存时间(month):61 vs 50],机器人组明显优于腔镜组(P<0.05)。单因素分析显示,淋巴结清扫数量是患者生存状况的影响因子;肿瘤直径、手术方式、淋巴结清扫组数、淋巴结清扫数量为患者无进展生存状况的影响因子。多因素分析显示生存状况无独立影响因子,肿瘤直径及手术方式为无进展生存状况的独立影响因子。结论达芬奇机器人Ⅰ期非小细胞肺癌患者术后生存状况与腔镜手术无差异,但无进展生存状况优于腔镜手术;达芬奇机器人手术淋巴结清扫更彻底,同时术中出血量更少。

Background and objective Da Vinci robotic surgery system is widely used in department of thoracic surgery.The aim of this study is to investigate the treatment outcome of stage I non-small cell lung cancer (NSCLC)via da Vinci Surgical System.Methods Clinical date of 347stage I NSCLC patients,who underwent lobectomy and system- atic node dissection from Jan.2012to Dec.2017,were reviewed.134patients underwent robot-assisted thoracic surgery (RATS)and 213patients underwent video-assisted thoracic surgery (VATS).To compare perioperative outcome (blood lose,postoperative drainage,drainage time,postoperative hospital stay,number of the LN dissection)and analyze overall survival (OS),disease free survival (DFS)of the two groups and prognostic factors.Results The RATS group got less blood lose [(49±39mL for RATS vs (202±239)mL for VATS,P<0.05]and postoperative drainage [Day 1:(248±123)mL for RATS vs (350±213)mL for VATS; Day 2:(288±189)mL for RATS vs (338±189)mL for VATS,P<0.05].There were no significant difference for drainage time (10±5for RATS vs 11±8for VATS,P<0.05)and postoperative hospital stay (13±6 for RATS vs 14±9for VATS,P<0.05)between the two groups.The RATS group harvested a more number of mean stations (5±2 for RATS vs 4±2for VATS)and amounts (18±9for RATS vs 1i±8 for VATS)of the lymph nodes,P<0.05.There wasno statistically significant difference of OS between RATS and VATS group [1-year OS:97.3%vs 96%;3-year OS:89.8%vs 83.1%;5-year OS:87.5%vs 70.3%;overall survival time (mean):61months vs 59months,P>0.05];corresponding there had a statistically significant difference of DFS between the two groups [1-year DFS:93.7%vs 91.3%;3-year DFS:87.7% vs 68.4%;5-year DFS:87.7%vs 52.5%;disease free survival time (mean):61months vs 50months,P<0.05].The univari- ate analysis found that the amounts of the lymph nodes dissection was the prognostic factor for OS and tumor diameter, surgical approach,stations and amounts of the lymph nodes dissection were respectively the prognostic factors for DFS. However,multivariate analysis found that there was not independently factors for OS,but the tumor diameter and surgi- cal approach were independently associated with DFS.Conclusion There was no significant difference about OS between the two groups,but the RATS got better DFS.RATS got more number of the LN dissection and less blood lose.