连续389例达芬奇机器人辅助胸腔镜肺叶切除术治疗非小细胞肺癌经验总结
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摘要
目的分析非小细胞肺癌(NSCLC)患者在行达芬奇机器人辅助下胸腔镜(RATS)肺叶切除术后的围术期指标,并总结手术经验。方法回顾性分析上海市胸科医院肺部肿瘤中心2013年5月—2016年12月连续389例行RATS肺叶切除术的Ⅰ~Ⅲa期NSCLC患者的临床资料。术前胸部CT扫描测量肿瘤直径(1.3±0.6)cm;临床病理分期:Ⅰa期153例,Ⅰb期148例,Ⅰc期32例,Ⅱb期26例,Ⅲa期30例;病灶位置:左肺上叶37例,左肺下叶101例;右肺上叶105例,右肺中叶32例,右肺下叶114例;腺癌380例,鳞癌9例。对围术期各项观察指标及住院总费用进行统计分析。结果 389例行RATS肺叶切除术的患者平均手术时间(91.5±30.8)min,术中估计出血量<100ml占95.8%,中转开胸4例(1.2%),围术期无输血病例,无术后30d内死亡病例。患者均行系统性淋巴结清扫,平均每例取淋巴结(5.7±1.5)组和(9.8±3.4)枚。术后第1天平均引流量(231.4±141.9)ml;术后留置胸管时间(4.0±1.5)d,无带管出院患者;术后平均住院时间(5.0±1.5)d,术后漏气(9.0%)为并发症的主要原因。患者平均住院总费用(自费部分+医保覆盖部分)(93 809.23元±13371.26)元。结论达芬奇机器人外科手术系统用于治疗可切除NSCLC患者安全、有效,可很好地弥补传统胸腔镜手术的不足。
Objective To analyze the perioperative parameters of non-small cell lung cancer patients who underwent robotic assisted lobectomy and summarize the surgical experience.MethodsRetrospective review was conducted on 389 consecutive patients who underwent robotic-assisted lobectomy for clinical stage Ⅰ to Ⅲa of non-small cell lung cancer at Shanghai lung Tumor Clinical Medical Center,Shanghai Chest Hospital between May 2013 and December 2016.The maximum diameter of tumor on preoperative chest CT scan was(1.3±0.6)cm;153 cases were in clinical stageⅠa,148 inⅠb,32 inⅠc,6 inⅡb,30 in Ⅲa;and the position of lesions for 37 cases was in left upper lobe,101 in left lower lobe,105 in right upper lobe,32 in right middle lobe,114 in right lower lobe;there were 380 cases of adenocarcinoma,and 9 cases of squamous carcinoma.Perioperative parameters and total hospital cost were analyzed.Results The average operative time of all 389 RATS lobectomy was(91.5±30.8)min;95.8 % of patientsestimated intraoperative blood loss were less than 100 ml;the conversion rate was 1.2%(4 cases);no patient received blood transfusion and no 30-day postoperative mortality occurred.All patients underwent systematic lymphadenectomy,and the average station and number of lymph nodes dissected were(5.7±1.5)and(9.8±3.4)respectively.The mean volume of chest tube drainage on the first postoperative day was(231.4±141.9)ml;the drainage period was(4.0±1.5)d and no patient was discharged with chest tube;the average postoperative hospital stay was(5.0±1.5)d;postoperative air leak was the primary complication,accounting for 9.0%.The mean total hospital costs(self pay+insurance coverage)was(93 809.23±13 371.26)Yuan. ConclusionsDa Vinci surgical robotic system is safe and effective for the treatment of operable NSCLC,and it can overcome many disadvantages of traditional VATS.
Objective To analyze the perioperative parameters of non-small cell lung cancer patients who underwent robotic assisted lobectomy and summarize the surgical experience.MethodsRetrospective review was conducted on 389 consecutive patients who underwent robotic-assisted lobectomy for clinical stage Ⅰ to Ⅲa of non-small cell lung cancer at Shanghai lung Tumor Clinical Medical Center,Shanghai Chest Hospital between May 2013 and December 2016.The maximum diameter of tumor on preoperative chest CT scan was(1.3±0.6)cm;153 cases were in clinical stageⅠa,148 inⅠb,32 inⅠc,6 inⅡb,30 in Ⅲa;and the position of lesions for 37 cases was in left upper lobe,101 in left lower lobe,105 in right upper lobe,32 in right middle lobe,114 in right lower lobe;there were 380 cases of adenocarcinoma,and 9 cases of squamous carcinoma.Perioperative parameters and total hospital cost were analyzed.Results The average operative time of all 389 RATS lobectomy was(91.5±30.8)min;95.8 % of patientsestimated intraoperative blood loss were less than 100 ml;the conversion rate was 1.2%(4 cases);no patient received blood transfusion and no 30-day postoperative mortality occurred.All patients underwent systematic lymphadenectomy,and the average station and number of lymph nodes dissected were(5.7±1.5)and(9.8±3.4)respectively.The mean volume of chest tube drainage on the first postoperative day was(231.4±141.9)ml;the drainage period was(4.0±1.5)d and no patient was discharged with chest tube;the average postoperative hospital stay was(5.0±1.5)d;postoperative air leak was the primary complication,accounting for 9.0%.The mean total hospital costs(self pay+insurance coverage)was(93 809.23±13 371.26)Yuan. ConclusionsDa Vinci surgical robotic system is safe and effective for the treatment of operable NSCLC,and it can overcome many disadvantages of traditional VATS.
引文
1 Thomas P,Doddoli C,Yena S,et al.VATS is an adequate oncological operation for stageⅠnon-small cell lung cancer[J].Eur J Cardiothorac Surg,2002,21(6):1094-1099.
2 Roviaro GC,Varoli F,Vergani C,et al.State of the art in thoracospic surgery:a personal experience of 2000videothoracoscopic procedures and an overview of the literature[J].Surg Endosc,2002,16(6):881-892.
3 Nagahiro I,Andou A,Aoe M,et al.Pulmonary function,postoperative pain,and serum cytokine level after lobectomy:a comparison of VATS and conventional procedure[J].Ann Thorac Surg,2001,72(2):362-365.
4 Forster R,Storck M,Schafer JR,et al.Thoracoscopy versus thoracotomy:aprospective comparison of trauma and quality of life[J].Langenbecks Arch Surg 2002,387(1):32-36.
5 Nifong LW,Chu VF,Bailey BM,et al.Robotic mitral valve repair:experience with the da Vinci system[J].Ann Thorac Surg,2003,75(2):438-442.
6 Tewari A,Peabody J,Sarle R,et al.Technique of da Vinci robot-assisted anatomic radical prostatectomy[J].Urology,2002,60(4):569-572.
7 Melfi FM,Mussi A.Robotically assisted lobectomy:learning curve and complications[J].Thorac Surg Clin,2008,18(3):289-295.
8 Giulianotti PC,Coratti A,Angelini M,et al.Robotics in general surgery:personal experience in a large community hospital[J].Arch Surg,2003,138(7):777-784.
9 Park BJ,Flores RM,Rusch VW.Robotic assistance for videoassisted thoracic surgical lobectomy:technique and initial results[J].J Thorac Cardiovasc Surg,2006,131(1):54-59.
10 Gharagozloo F,Margolis M,Tempesta B,et al.Robot-assisted lobectomy for early-stage lung cancer:report of 100consecutive cases[J].Ann Thorac Surg 2009;88(2):380-384.
11 刘伦旭,车国卫,蒲强,等.单项式全胸腔镜肺叶切除[J].中华胸心血管外科杂志,2008,24(3):156-158
12 Veronesi G,Galetta D,Maisonneuve P,et al.Four-arm robotic lobectomy for the treatment of early-stage lung cancer[J].J Thorac Cardiovasc Surg,2010,140(1):19-25.
13 Augustin F,Bodner J,Wykypiel H,et al.Initial experience with robotic lung lobectomy:report of two different approaches[J].Surg Endosc,2011,25(1):108-113.
14 Bodner J,Wykypiel H,Wetscher G,et al.First experiences with the da Vinci operating robot in thoracic surgery[J].Eur J Cardiothorac Surg,2004,25(5):844-851.
15 Zhao X,Qian L,Lin H,et al.Robot-assisted lobectomy for nonsmall cell lung cancer in China:initial experience and techniques[J].J Thorac Dis,2010,2(1):26-28.
16 Anderson CA,Hellan M,Falebella A,et al.Robotic-assisted lung resection for malignant disease[J].Innovations(Phila),2007,2(5):254-258.
17 Giulianotti PC,Buchs NC,Caravaglios G,et al.Robot-assisted lung resection:outcomes and technical details[J].Interact Cardiovasc Thorac Surg,2010,11(4):388-392.
18 Whitson BA,DCunha J,Andre RS,et al.Thoracoscopic versus thoracotomy approaches to lobectomy:differential impairment of cellular immunity[J].Ann Thorac Surg,2008,86(6):1735-1744.
19 Cerfolio RJ,Bryant AS,Skylizard L,et al.Initial consecutive experience of completely portal robotic pulmonary resection with 4arms[J].J Thorac Cardiovasc Surg,2011,142(4):740-746.
20 Chang L,Satava RM,Pellegrini CA,et al.Robotic surgery:identifing the learning curve through objective mearsurement of skill[J].Surg Endosc,2003,17(11):1744-1748.
21 Hernandez J,Bann S,Munz K,et al.Qualitative and quantitative analysis of the learning curve of a simulated task on the da Vinci system[J].Surg Endosc,2004,18(3):372-378.
22 Jane 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[J].Innovations(Phila),2011,6(5):305-310.
23 Park BJ,Flores RM.Cost comparison of robotic,vats and thoracotomy approaches to pulmonary lobectomy[J].Thorac Surg Clin,2008,18(3):297-300.
2 Roviaro GC,Varoli F,Vergani C,et al.State of the art in thoracospic surgery:a personal experience of 2000videothoracoscopic procedures and an overview of the literature[J].Surg Endosc,2002,16(6):881-892.
3 Nagahiro I,Andou A,Aoe M,et al.Pulmonary function,postoperative pain,and serum cytokine level after lobectomy:a comparison of VATS and conventional procedure[J].Ann Thorac Surg,2001,72(2):362-365.
4 Forster R,Storck M,Schafer JR,et al.Thoracoscopy versus thoracotomy:aprospective comparison of trauma and quality of life[J].Langenbecks Arch Surg 2002,387(1):32-36.
5 Nifong LW,Chu VF,Bailey BM,et al.Robotic mitral valve repair:experience with the da Vinci system[J].Ann Thorac Surg,2003,75(2):438-442.
6 Tewari A,Peabody J,Sarle R,et al.Technique of da Vinci robot-assisted anatomic radical prostatectomy[J].Urology,2002,60(4):569-572.
7 Melfi FM,Mussi A.Robotically assisted lobectomy:learning curve and complications[J].Thorac Surg Clin,2008,18(3):289-295.
8 Giulianotti PC,Coratti A,Angelini M,et al.Robotics in general surgery:personal experience in a large community hospital[J].Arch Surg,2003,138(7):777-784.
9 Park BJ,Flores RM,Rusch VW.Robotic assistance for videoassisted thoracic surgical lobectomy:technique and initial results[J].J Thorac Cardiovasc Surg,2006,131(1):54-59.
10 Gharagozloo F,Margolis M,Tempesta B,et al.Robot-assisted lobectomy for early-stage lung cancer:report of 100consecutive cases[J].Ann Thorac Surg 2009;88(2):380-384.
11 刘伦旭,车国卫,蒲强,等.单项式全胸腔镜肺叶切除[J].中华胸心血管外科杂志,2008,24(3):156-158
12 Veronesi G,Galetta D,Maisonneuve P,et al.Four-arm robotic lobectomy for the treatment of early-stage lung cancer[J].J Thorac Cardiovasc Surg,2010,140(1):19-25.
13 Augustin F,Bodner J,Wykypiel H,et al.Initial experience with robotic lung lobectomy:report of two different approaches[J].Surg Endosc,2011,25(1):108-113.
14 Bodner J,Wykypiel H,Wetscher G,et al.First experiences with the da Vinci operating robot in thoracic surgery[J].Eur J Cardiothorac Surg,2004,25(5):844-851.
15 Zhao X,Qian L,Lin H,et al.Robot-assisted lobectomy for nonsmall cell lung cancer in China:initial experience and techniques[J].J Thorac Dis,2010,2(1):26-28.
16 Anderson CA,Hellan M,Falebella A,et al.Robotic-assisted lung resection for malignant disease[J].Innovations(Phila),2007,2(5):254-258.
17 Giulianotti PC,Buchs NC,Caravaglios G,et al.Robot-assisted lung resection:outcomes and technical details[J].Interact Cardiovasc Thorac Surg,2010,11(4):388-392.
18 Whitson BA,DCunha J,Andre RS,et al.Thoracoscopic versus thoracotomy approaches to lobectomy:differential impairment of cellular immunity[J].Ann Thorac Surg,2008,86(6):1735-1744.
19 Cerfolio RJ,Bryant AS,Skylizard L,et al.Initial consecutive experience of completely portal robotic pulmonary resection with 4arms[J].J Thorac Cardiovasc Surg,2011,142(4):740-746.
20 Chang L,Satava RM,Pellegrini CA,et al.Robotic surgery:identifing the learning curve through objective mearsurement of skill[J].Surg Endosc,2003,17(11):1744-1748.
21 Hernandez J,Bann S,Munz K,et al.Qualitative and quantitative analysis of the learning curve of a simulated task on the da Vinci system[J].Surg Endosc,2004,18(3):372-378.
22 Jane 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[J].Innovations(Phila),2011,6(5):305-310.
23 Park BJ,Flores RM.Cost comparison of robotic,vats and thoracotomy approaches to pulmonary lobectomy[J].Thorac Surg Clin,2008,18(3):297-300.