Abstract
Objectives
Robot-assisted thoracoscopic surgery (RATS) for primary lung cancer has been spreading rapidly in Japan. While RATS has various technical advantages over video-assisted thoracoscopic surgery (VATS), the quality of surgery from an oncologic viewpoint must be maintained, and the evaluation of medium- to long-term survival outcomes is momentous.
Methods
This study included 299 patients with primary lung cancer (VATS, n = 246; RATS, n = 53) who underwent lobectomy and mediastinal lymph node dissection at our hospital. We reviewed and compared perioperative factors, the number of dissected lymph nodes, and postoperative recurrence between the VATS and RATS groups. We also compared the postoperative survival rates among 98 patients (49 patients in each group) whose background factors were adjusted by propensity score matching (PSM).
Results
After PSM, a significant difference was found in the total operative time between the two groups (p < 0.01); however, no difference was found between the RATS console time and VATS total operative time (p = 0.68). Postoperative recurrence was not significantly different between the groups (VATS, 14%; RATS, 6%; p = 0.18). The 3-year recurrence-free survival rate was not significantly different between the groups (VATS, 91.7%; RATS, 91.2%; p = 0.21).
Conclusions
RATS had promising survival results, which were similar to those of VATS even after PSM. Further case series and longer observation periods are needed to determine what technical benefits of RATS may affect the prognosis of lung cancer.
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References
S Paul AJ Isaacs T Treasure NK Altorki A Sedrakyan 2014 Long term survival with thoracoscopic versus open lobectomy: propensity matched comparative analysis using SEER-medicare database BMJ 349 g5575
V Rauma S Andersson EM Robinson JV Rasanen H Sintonen JA Salo 2019 Thoracotomy and VATS surgery in local non-small-cell lung cancer: differences in long-term health-related quality of life Clin Lung Cancer 20 5 378 383
M Bendixen C Kronborg OD Jorgensen C Andersen PB Licht 2019 Cost-utility analysis of minimally invasive surgery for lung cancer: a randomized controlled trial Eur J Cardiothorac Surg 56 4 754 761
FM Melfi GF Menconi AM Mariani CA Angeletti 2002 Early experience with robotic technology for thoracoscopic surgery Eur J Cardiothorac Surg 21 5 864 868
H Nakamura T Suda N Ikeda M Okada H Date M Oda 2014 Initial results of robot-assisted thoracoscopic surgery in Japan Gen Thorac Cardiovasc Surg 62 12 720 725
T Haruki K Aokage T Miyoshi T Hishida G Ishii J Yoshida 2015 Mediastinal nodal involvement in patients with clinical stage I non-small-cell lung cancer: possibility of rational lymph node dissection J Thorac Oncol 10 6 930 936
D Dindo N Demartines PA Clavien 2004 Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey Ann Surg 240 2 205 213
T Haruki K Miwa K Araki Y Taniguchi H Nakamura 2016 Distribution and prevalence of locoregional recurrence after video-assisted thoracoscopic surgery for primary lung cancer Thorac Cardiovasc Surg 64 6 526 532
Y Taniguchi H Nakamura K Miwa T Haruki K Araki Y Takagi 2017 Initial results of robotic surgery for primary lung cancer: feasibility, safety and learning curve Yonago Acta Med 60 3 162 166
BE Louie AS Farivar RW Aye E Vallieres 2012 Early experience with robotic lung resection results in similar operative outcomes and morbidity when compared with matched video-assisted thoracoscopic surgery cases Ann Thorac Surg 93 5 1598 1604
AS Farivar RJ Cerfolio E Vallieres AW Knight A Bryant V Lingala 2014 Comparing robotic lung resection with thoracotomy and video-assisted thoracoscopic surgery cases entered into the society of thoracic surgeons database Innovations 9 1 10 15
M Kent T Wang R Whyte T Curran R Flores S Gangadharan 2014 Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database Ann Thorac Surg 97 1 236 244
J Mahieu P Rinieri M Bubenheim E Calenda J Melki C Peillon 2016 Robot-assisted thoracoscopic surgery versus video-assisted thoracoscopic surgery for lung lobectomy: can a robotic approach improve short-term outcomes and operative safety? Thorac Cardiovasc Surg 64 4 354 362
PJ Kneuertz DH Cheufou DM D'Souza K Mardanzai M Abdel-Rasoul D Theegarten 2019 Propensity-score adjusted comparison of pathologic nodal upstaging by robotic, video-assisted thoracoscopic, and open lobectomy for non-small cell lung cancer J Thorac Cardiovasc Surg 158 5 1457 66.e2
HX Yang KM Woo CS Sima MS Bains PS Adusumilli J Huang 2017 Long-term survival based on the surgical approach to lobectomy for clinical stage I nonsmall cell lung cancer: comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy Ann Surg 265 2 431 437
Huang L Shen Y Onaitis M 2019 Comparative study of anatomic lung resection by robotic vs. video-assisted thoracoscopic surgery J Thorac Dis 11 4 1243 1250
G Veronesi R Cerfolio R Cingolani JC Rueckert L Soler A Toker 2016 Report on first international workshop on robotic surgery in thoracic oncology Front Oncol 6 214
D Nguyen F Gharagozloo B Tempesta M Meyer A Gruessner 2019 Long-term results of robotic anatomical segmentectomy for early-stage non-small-cell lung cancer Eur J Cardiothorac Surg 55 3 427 433
G Veronesi B Park R Cerfolio M Dylewski A Toker JP Fontaine 2018 Robotic resection of stage III lung cancer: an international retrospective study Eur J Cardiothorac Surg 54 5 912 919
BE Lee RJ Korst E Kletsman JR Rutledge 2014 Transitioning from video-assisted thoracic surgical lobectomy to robotics for lung cancer: Are there outcomes advantages? J Thorac Cardiovasc Surg 147 2 724 729
Toker A Ozyurtkan MO Demirhan O Ayalp K Kaba E Uyumaz E 2016 Lymph node dissection in surgery for lung cancer: comparison of open vs. video-assisted vs. robotic-assisted approaches Ann Thorac Cardiovasc Surg 22 5 284 290
JL Wilson BE Louie RJ Cerfolio BJ Park E Vallieres RW Aye 2014 The prevalence of nodal upstaging during robotic lung resection in early stage non-small cell lung cancer Ann Thorac Surg 97 6 1901 1906
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We thank Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.
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Haruki, T., Kubouchi, Y., Takagi, Y. et al. Comparison of medium-term survival outcomes between robot-assisted thoracoscopic surgery and video-assisted thoracoscopic surgery in treating primary lung cancer. Gen Thorac Cardiovasc Surg 68, 984–992 (2020). https://doi.org/10.1007/s11748-020-01312-7
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DOI: https://doi.org/10.1007/s11748-020-01312-7