Journal of clinical medicine · 2022
Long-Term Outcomes of Robotic-Assisted, Video-Assisted and Open Surgery in Non-Small Cell Lung Cancer: A Matched Analysis.
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Casiraghi Monica, Mariolo Alessio Vincenzo, Mohamed Shehab, Sedda Giulia, Maisonneuve Patrick, Mazzella Antonio, Lo Iacono Giorgio, Petrella Francesco, Spaggiari Lorenzo
Аннотация
INTRODUCTION: This study makes a comparison between stage I non-small cell lung cancer (NSCLC) patients subjected to either robotic-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS) or open thoracotomy, with the aim to evaluate differences between these three approaches in terms of oncological outcomes.
METHOD: We reviewed data from 1367 consecutive patients who, between 2011 and 2017, underwent lobectomy for NSCLC with either open surgery, VATS or RATS, and performed a matched case-control study based on patients' age, gender, clinical stage (IA, IB) and ASA score.
RESULTS: 180 patients (n = 72 RATS, n = 36 VATS, n = 72 open) were analyzed. Complication rates were found to be comparable (72.2% open, 86.1% VATS, 81.9% RATS), with similar grades of severity. The median number of resected lymph nodes was higher in open surgery (n = 22) than in VATS (n = 15; p = 0.0001) and in RATS (n = 17; p = 0.004). Pathological N2 upstaging was higher in open surgery (9.7%) compared to VATS (5.6%) and RATS (5.6%). However, the recurrence rate in VATS was significantly higher than in RATS (log rank p = 0.03). No statistically significant differences were detected in 5-year OS and cancer-specific survival.
CONCLUSIONS: no differences were found in OS and cancer-specific survival between VATS, RATS and open lobectomy for stage I NSCLC patients; even if in VATS, the incidence of recurrences, in particular local recurrences, was higher than in RATS and in open surgery.
METHOD: We reviewed data from 1367 consecutive patients who, between 2011 and 2017, underwent lobectomy for NSCLC with either open surgery, VATS or RATS, and performed a matched case-control study based on patients' age, gender, clinical stage (IA, IB) and ASA score.
RESULTS: 180 patients (n = 72 RATS, n = 36 VATS, n = 72 open) were analyzed. Complication rates were found to be comparable (72.2% open, 86.1% VATS, 81.9% RATS), with similar grades of severity. The median number of resected lymph nodes was higher in open surgery (n = 22) than in VATS (n = 15; p = 0.0001) and in RATS (n = 17; p = 0.004). Pathological N2 upstaging was higher in open surgery (9.7%) compared to VATS (5.6%) and RATS (5.6%). However, the recurrence rate in VATS was significantly higher than in RATS (log rank p = 0.03). No statistically significant differences were detected in 5-year OS and cancer-specific survival.
CONCLUSIONS: no differences were found in OS and cancer-specific survival between VATS, RATS and open lobectomy for stage I NSCLC patients; even if in VATS, the incidence of recurrences, in particular local recurrences, was higher than in RATS and in open surgery.