连续1000例机器人辅助胸腔镜肺部手术回顾性分析
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摘要
目的分析我中心连续1 000例机器人肺部手术近期临床结果,并总结相关经验。方法回顾性分析上海市胸科医院肺部肿瘤临床医学中心2009年5月至2018年6月间行机器人辅助胸腔镜(RATS)肺部手术的1 000例患者的临床病理资料及围手术期结局,并将RATS肺叶切除手术与同一时期行胸腔镜下肺叶切除病例行倾向性匹配分析,比较两者围手术期结局。其中男327例、女673例,平均年龄(56.21±11.33)岁;行肺叶切除866例(包括11例双肺叶切除),亚肺叶切除129例,袖式切除5例。术后病理腺癌875例,鳞癌52例,良性肿瘤73例,大部分为Ⅰ期患者,占比90.50%。结果平均手术时间(90.31±19.70)min,术中出血量<100 ml占95.70%,9例(0.90%)患者中转开胸,清扫淋巴结组数平均(5.59±1.36)组,取淋巴结个数平均(9.60±3.21)枚;术后第1 d平均引流量(229.19±131.67)ml,术后平均置管时间(3.85±1.43)d;术后30 d内有1例患者死于肺栓塞,189例(18.9%)患者出现术后并发症,主要为术后漏气>5 d;每例患者总住院费用(92 710.53±12 367.23)元。相比于传统腔镜手术,达芬奇机器人肺叶切除可减少术中出血量,缩短术后置管时间及住院时间;在手术时间、中转率、淋巴结清扫、术后并发症及术后死亡率方面二者未见差异。结论达芬奇机器人辅助胸腔镜手术安全有效,术中中转率及术后并发症均较低,可有效弥补传统腔镜的不足。
Objective To analyze the perioperative outcome of consecutive 1 000 patients undergoing robotic lung resection and summarize surgical experience. Methods We retrospectively reviewed the clinical data of 1 000 patients undergoing robotic lung resection between May 2009 and June 2018 in Shanghai Lung Tumor Clinical Medical Center. Robotic lobectomy was compared with traditional VATS over the same period using a propensity-matched analysis. There were 327 males and 673 females at average age of 56.21±11.33 years. Lobectomy was performed in 866patients(11 bilobectomy included), sublobar resection was performed in 129 patients, sleeve lobectomy was performed in the remaining 5 patients. Pathology was as follows: adenocarcinoma in 875 patients, squamous carcinoma in 52 patients,benign tumors in 73 patients. 90.5% of the primary lung cancer were in stage Ⅰ. Results The mean operative time was90.31±19.70 min; 95.70% of patients' estimated blood loss was less than 100 ml. Conversion rate to thoracotomy was0.90%(9 patients). The average lymph node station and count harvested was 5.59±1.36 and 9.60±3.21 respectively. The mean volume of chest tube drainage on the first postoperative day was 229.19±131.67 ml. Median chest tube time was3.85±1.43 d. There was 1 in-hospital death due to pulmonary embolism. A total of 189 patients had postoperative complications(18.90%) whose majority was postoperative air leak more than 5 days. The mean overall hospital costs was92 710.53±12 367.23 Yuan. Compared with VATS, RATS was associated with significant reduction in intraoperative blood loss, time to chest tube removal and postoperative hospital stay. The operative time, conversion rate, lymph nodes removed, morbidity and mortality were similar between the two groups. Conclusion Robotic-assisted lung resection is safe and effective with low conversion rate and less complications, and it can overcome many disadvantages of traditional VATS.
Objective To analyze the perioperative outcome of consecutive 1 000 patients undergoing robotic lung resection and summarize surgical experience. Methods We retrospectively reviewed the clinical data of 1 000 patients undergoing robotic lung resection between May 2009 and June 2018 in Shanghai Lung Tumor Clinical Medical Center. Robotic lobectomy was compared with traditional VATS over the same period using a propensity-matched analysis. There were 327 males and 673 females at average age of 56.21±11.33 years. Lobectomy was performed in 866patients(11 bilobectomy included), sublobar resection was performed in 129 patients, sleeve lobectomy was performed in the remaining 5 patients. Pathology was as follows: adenocarcinoma in 875 patients, squamous carcinoma in 52 patients,benign tumors in 73 patients. 90.5% of the primary lung cancer were in stage Ⅰ. Results The mean operative time was90.31±19.70 min; 95.70% of patients' estimated blood loss was less than 100 ml. Conversion rate to thoracotomy was0.90%(9 patients). The average lymph node station and count harvested was 5.59±1.36 and 9.60±3.21 respectively. The mean volume of chest tube drainage on the first postoperative day was 229.19±131.67 ml. Median chest tube time was3.85±1.43 d. There was 1 in-hospital death due to pulmonary embolism. A total of 189 patients had postoperative complications(18.90%) whose majority was postoperative air leak more than 5 days. The mean overall hospital costs was92 710.53±12 367.23 Yuan. Compared with VATS, RATS was associated with significant reduction in intraoperative blood loss, time to chest tube removal and postoperative hospital stay. The operative time, conversion rate, lymph nodes removed, morbidity and mortality were similar between the two groups. Conclusion Robotic-assisted lung resection is safe and effective with low conversion rate and less complications, and it can overcome many disadvantages of traditional VATS.
引文
1 Kaseda S, Aoki T, Hangai N, et al. Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. Ann Thorac Surg, 2000, 70(5):1644-1646.
2 Roviaro G, Varoli F, Vergani C, et al. Long-term survival after videothoracoscopic lobectomy for stageⅠlung cancer. Chest,2004,126(3):725-732.
3 Ferguson J, Walker W. Developing a VATS lobectomy programme--can VATS lobectomy be taught? Eur J Cardiothorac Surg, 2006, 29(5):806-809.
4 McKenna RJ Jr. Complications and learning curves for videoassisted thoracic surgery lobectomy. Thorac Surg Clin, 2008, 18(3):275-280.
5 Cerfolio RJ, Bryant AS, Skylizard L, et al. Initial consecutive experience of completely portal robotic pulmonary resection with 4arms. J Thorac Cardiovasc Surg, 2011, 142(4):740-746.
6 Gharagozloo F, Margolis M, Tempesta B, et al. Robot-assisted lobectomy for early-stage lung cancer:report of 100 consecutive cases. Ann Thorac Surg, 2009, 88(2):380-384.
7 Yoshino I, Hashizume M, Shimada M, et al. Video-assisted thoracoscopic extirpation of a posterior mediastinal mass using the da Vinci computer enhanced surgical system. Ann Thorac Surg,2002, 74(4):1235-1237.
8 Yang CF, Meyerhoff RR, Mayne NR, et al. Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer. Eur J Cardiothorac Surg, 2016, 49(6):1615-1623.
9 Farivar AS, Cerfolio RJ, Vallieres E, et al. Comparing robotic lung resection with thoracotomy and video-assisted thoracoscopic surgery cases entered into the Society of Thoracic Surgeons database. Innovations(Phila), 2014, 9(1):10-15.
10 Zhang L, Gao S. Robot-assisted thoracic surgery versus open thoracic surgery for lung cancer:a system review and metaanalysis. Int J Clin Exp Med, 2015, 8(10):17804-17810.
11刘伦旭,车国卫,蒲强,等.单项式全胸腔镜肺叶切除术.中华胸心血管外科杂志,2008, 24(3):156-158.
12 Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization Classification of Lung Tumors:impact of genetic, clinical and radiologic advances since the 2004classification. J Thorac Oncol, 2015, 10(9):1243-1260.
13 Asamura H, Chansky K, Crowley J, et al. The International Association for the Study of Lung Cancer Lung Cancer Staging Project:Proposals for the revision of the N descriptors in the forthcoming 8th edition of the TNM classification for lung cancer.J Thorac Oncol, 2015, 10(12):1675-1684.
14许世广,王述民.浅谈达芬奇机器人手术500例体会.中国胸心血管外科临床杂志,2015, 22(10):895-900.
15 Agzarian J, Fahim C, Shargall Y, et al. The use of robotic-assisted thoracic surgery for lung resection:a comprehensive systematic review. Semin Thorac Cardiovasc Surg, 2016, 28(1):182-192.
16 Mahieu J, Rinieri P, Bubenheim M, et al. 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, 2016,64(4):354-362.
17 Liang H, Liang W, Zhao L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer:a meta-analysis. Ann Surg, 2018, 268(2):254-259.
18 Demir A, Ayalp K, Ozkan B, et al. Robotic and video-assisted thoracic surgery lung segmentectomy for malignant and benign lesions. Interact Cardiovasc Thorac Surg, 2015, 20(3):304-309.
19 Toker A, Ozyurtkan MO, Kaba E, et al. Robotic anatomic lung resections:the initial experience and description of learning in 102cases. Surg Endosc, 2016, 30(2):676-683.
20 Jang HJ, Lee HS, Park SY, et al. Comparison of the early robotassisted lobectomy experience to video-assisted thoracic surgery lobectomy for lung cancer:a single-institution case series matching study. Innovations(Phila), 2011, 6(5):305-310.
21 Veronesi G, Galetta D, Maisonneuve P, et al. Four-arm roboticlobectomy for the treatment of early-stage lung cancer. J Thorac Cardiovasc Surg, 2010,140(1):19-25.
22 Wilson JL, Louie BE, Cerfolio RJ, et al. The prevalence of nodal upstaging during robotic lung resection in early stage non-small cell lung cancer. Ann Thorac Surg, 2014,97(6):1901-1906.
23 Park BJ, Melfi F, Mussi A, et al.Robotic lobectomy for non-small cell lung cancer(NSCLC):long-term oncologic results. J Thorac Cardiovasc Surg, 2012,143(2):383-389.
24 Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stageⅠnonsmall cell lung cancer:comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265(2):431-437.
25 Park BJ, Flores RM. Cost comparison of robotic, video-assisted thoracic surgery and thoracotomy approaches to pulmonary lobectomy. Thorac Surg Clin, 2008,18(3):297-300.
2 Roviaro G, Varoli F, Vergani C, et al. Long-term survival after videothoracoscopic lobectomy for stageⅠlung cancer. Chest,2004,126(3):725-732.
3 Ferguson J, Walker W. Developing a VATS lobectomy programme--can VATS lobectomy be taught? Eur J Cardiothorac Surg, 2006, 29(5):806-809.
4 McKenna RJ Jr. Complications and learning curves for videoassisted thoracic surgery lobectomy. Thorac Surg Clin, 2008, 18(3):275-280.
5 Cerfolio RJ, Bryant AS, Skylizard L, et al. Initial consecutive experience of completely portal robotic pulmonary resection with 4arms. J Thorac Cardiovasc Surg, 2011, 142(4):740-746.
6 Gharagozloo F, Margolis M, Tempesta B, et al. Robot-assisted lobectomy for early-stage lung cancer:report of 100 consecutive cases. Ann Thorac Surg, 2009, 88(2):380-384.
7 Yoshino I, Hashizume M, Shimada M, et al. Video-assisted thoracoscopic extirpation of a posterior mediastinal mass using the da Vinci computer enhanced surgical system. Ann Thorac Surg,2002, 74(4):1235-1237.
8 Yang CF, Meyerhoff RR, Mayne NR, et al. Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer. Eur J Cardiothorac Surg, 2016, 49(6):1615-1623.
9 Farivar AS, Cerfolio RJ, Vallieres E, et al. Comparing robotic lung resection with thoracotomy and video-assisted thoracoscopic surgery cases entered into the Society of Thoracic Surgeons database. Innovations(Phila), 2014, 9(1):10-15.
10 Zhang L, Gao S. Robot-assisted thoracic surgery versus open thoracic surgery for lung cancer:a system review and metaanalysis. Int J Clin Exp Med, 2015, 8(10):17804-17810.
11刘伦旭,车国卫,蒲强,等.单项式全胸腔镜肺叶切除术.中华胸心血管外科杂志,2008, 24(3):156-158.
12 Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization Classification of Lung Tumors:impact of genetic, clinical and radiologic advances since the 2004classification. J Thorac Oncol, 2015, 10(9):1243-1260.
13 Asamura H, Chansky K, Crowley J, et al. The International Association for the Study of Lung Cancer Lung Cancer Staging Project:Proposals for the revision of the N descriptors in the forthcoming 8th edition of the TNM classification for lung cancer.J Thorac Oncol, 2015, 10(12):1675-1684.
14许世广,王述民.浅谈达芬奇机器人手术500例体会.中国胸心血管外科临床杂志,2015, 22(10):895-900.
15 Agzarian J, Fahim C, Shargall Y, et al. The use of robotic-assisted thoracic surgery for lung resection:a comprehensive systematic review. Semin Thorac Cardiovasc Surg, 2016, 28(1):182-192.
16 Mahieu J, Rinieri P, Bubenheim M, et al. 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, 2016,64(4):354-362.
17 Liang H, Liang W, Zhao L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer:a meta-analysis. Ann Surg, 2018, 268(2):254-259.
18 Demir A, Ayalp K, Ozkan B, et al. Robotic and video-assisted thoracic surgery lung segmentectomy for malignant and benign lesions. Interact Cardiovasc Thorac Surg, 2015, 20(3):304-309.
19 Toker A, Ozyurtkan MO, Kaba E, et al. Robotic anatomic lung resections:the initial experience and description of learning in 102cases. Surg Endosc, 2016, 30(2):676-683.
20 Jang HJ, Lee HS, Park SY, et al. Comparison of the early robotassisted lobectomy experience to video-assisted thoracic surgery lobectomy for lung cancer:a single-institution case series matching study. Innovations(Phila), 2011, 6(5):305-310.
21 Veronesi G, Galetta D, Maisonneuve P, et al. Four-arm roboticlobectomy for the treatment of early-stage lung cancer. J Thorac Cardiovasc Surg, 2010,140(1):19-25.
22 Wilson JL, Louie BE, Cerfolio RJ, et al. The prevalence of nodal upstaging during robotic lung resection in early stage non-small cell lung cancer. Ann Thorac Surg, 2014,97(6):1901-1906.
23 Park BJ, Melfi F, Mussi A, et al.Robotic lobectomy for non-small cell lung cancer(NSCLC):long-term oncologic results. J Thorac Cardiovasc Surg, 2012,143(2):383-389.
24 Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stageⅠnonsmall cell lung cancer:comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265(2):431-437.
25 Park BJ, Flores RM. Cost comparison of robotic, video-assisted thoracic surgery and thoracotomy approaches to pulmonary lobectomy. Thorac Surg Clin, 2008,18(3):297-300.