Comparison of Video-Assisted Thoracoscopic Surgery and Robotic Approaches for Clinical Stage I and Stage II Non-Small Cell Lung Cancer Using The Society of Thoracic Surgeons Database

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• 作者：Brian E. Louie ; MD^a ; ^{brian.louie@swedish.org" class="auth_mail" title="E-mail the corresponding author} ; Jennifer L. Wilson ; MD^b ; Sunghee Kim ; PhD^c ; Robert J. Cerfolio ; MD^d ; Bernard J. Park ; MD^e ; Alexander S. Farivar ; MD^a ; Eric Valli&egrave ; res ; MD^a ; Ralph W. Aye ; MD^a ; William R. Burfeind Jr. ; MD^f ; Mark I. Block ; MD^g
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：102
• 期：3
• 页码：917-924
• 全文大小：213 K

文摘

Data from selected centers show that robotic lobectomy is safe and effective and has 30-day mortality comparable to that of video-assisted thoracoscopic surgery (VATS). However, widespread adoption of robotic lobectomy is controversial. We used The Society of Thoracic Surgeons General Thoracic Surgery (STS-GTS) Database to evaluate quality metrics for these 2 minimally invasive lobectomy techniques.

ec_2">Methods

A database query for primary clinical stage I or stage II non-small cell lung cancer (NSCLC) at high-volume centers from 2009 to 2013 identified 1,220 robotic lobectomies and 12,378 VATS procedures. Quality metrics evaluated included operative morbidity, 30-day mortality, and nodal upstaging, defined as cN0 to pN1. Multivariable logistic regression was used to evaluate nodal upstaging.

ec_3">Results

Patients undergoing robotic lobectomy were older, less active, and less likely to be an ever smoker and had higher body mass index (BMI) (all <em>pem> < 0.05). They were also more likely to have coronary heart disease or hypertension (all <em>pem> < 0.001) and to have had preoperative mediastinal staging (<em>pem> < 0.0001).

Robotic lobectomy operative times were longer (median 186 versus 173 minutes; <em>pem> < 0.001); all other operative measurements were similar. All postoperative outcomes were similar, including complications and 30-day mortality (robotic lobectomy, 0.6% versus VATS, 0.8%; <em>pem> = 0.4). Median length of stay was 4 days for both, but a higher proportion of patients undergoing robotic lobectomy had hospital stays less than 4 days (48% versus 39%; <em>pem> < 0.001). Nodal upstaging overall was similar (<em>pem> = 0.6) but with trends favoring VATS in the cT1b group and robotic lobectomy in the cT2a group.

ec_4">Conclusions

Patients undergoing robotic lobectomy had more comorbidities and robotic lobectomy operative times were longer, but quality outcome measures, including complications, hospital stay, 30-day mortality, and nodal upstaging, suggest that robotic lobectomy and VATS are equivalent.