机器人辅助与胸腔镜辅助右肺上叶切除术治疗非小细胞肺癌的回顾性队列研究

Perioperative outcomes of robot-assisted versus video-assisted right upper lobectomy in non-small cell lung cancer:A retrospective cohort study

目的总结单中心机器人辅助与胸腔镜辅助右肺上叶切除术治疗非小细胞肺癌的临床结果,探讨其安全性及实施要点。方法回顾性分析2015~2018年我中心罗清泉团队采用微创手术完成右肺上叶切除术治疗579例非小细胞肺癌患者的临床资料,其中男246例、女333例,年龄33~78岁。将579例患者按手术方式分为机器人辅助胸外科手术(robot-assisted thoracic surgery,RATS)组(283例)和电视辅助胸腔镜手术(video-assisted thoracic surgery,VATS)组(296例);比较两组患者的基线数据以及手术时间、淋巴结清扫情况、术中出血量、中转开胸情况、术后引流时间、术后住院时间、术后并发症、术后30 d死亡及手术费用等围术期结果。结果两组基线数据差异无统计学意义(P>0.05),均无术中输血及术后30 d死亡。RATS组手术时间[(90.22±12.16)min vs.(92.68±12.26)min,P=0.016]、胸腔引流时间[(3.55±1.38)d vs.(4.16±1.58)d,P<0.001]及术后住院时间[(4.67±1.43)d vs.(5.31±1.59)d,P<0.001]均较VATS组缩短。淋巴结清扫、术中出血量、中转开胸率及术后并发症方面两组差异无统计学意义(P>0.05)。RATS组手术总费用更高[(93275.46±13276.69)元vs.(67082.58±12978.17)元,P<0.001]。结论RATS与VATS行右肺上叶切除治疗非小细胞肺癌有效性及安全性满意,两种术式的围术期结果基本相当,但RATS手术时间和术后住院时间更短。

Objective To summarize the perioperative outcome of patients undergoing robot-assisted thoracic surgery(RATS)or four-port single-direction video-assisted thoracic surgery(VATS)right upper lobectomy(RUL),and to discuss the safety and the essentials of the surgery.Methods The clinical data of 579 patients with non-small cell lung cancer(NSCLC)undergoing minimally invasive RUL in Dr.Luo Qingquan’s team of our center from 2015 to 2018 were retrospectively analyzed.There were 246 males and 333 females aged 33-78 years.The 579 patients were divided into a RATS group(n=283)and a VATS group(n=296)according to surgical methods.Baseline characteristics and perioperative outcomes including dissected lymph nodes,postoperative duration of drainage,postoperative hospital stay,postoperative complications and surgery cost were compared between the two groups.Results There was no significant difference in baseline data between the two groups(P>0.05),and no postoperative 30 d mortality or intraoperative blood transfusion was observed.Compared with VATS,RATS had shorter operation time(90.22±12.16 min vs.92.68±12.26 min,P=0.016),postoperative hospital stay(4.67±1.43 d vs.5.31±1.59 d,P<0.001)and time of drainage(3.55±1.38 d vs.4.16±1.58 d,P<0.001).No significant difference was observed between the two groups in the lymph nodes dissection,blood loss volume,conversion rate or complications.The cost of RATS was much higher than that of VATS(93275.46±13276.69 yuan vs.67082.58±12978.17 yuan,P<0.001).Conclusion The safety and effectiveness of robot-assisted and video-assisted RUL are satisfactory,and they have similar perioperative outcomes.However,RATS costs relatively shorter operation time and postoperative hospital stay.