Comparison Of Short-term And Long-term Survival Between Robot-assisted And Thoracoscopic Surgery For Non-small Cell Lung Cancer

ObjectiveTo compare the short and long-term survival of patients with stage I non-small cell lung cancer(NSCLC)undergoing robot-assisted thoracic surgery(RATS)and videoassisted thoracic surgery(VATS).MethodsThe clinical,pathological and survival data of 396 stage I NSCLC patients treated by RATS or VATS in General Hospital of Northern Theater Command Hospital from January 2012 to December 2019 were analyzed retrospectively.There were 209 males and 187 females with a mean age of(61.58 ± 8.67)years.They were divided into RATS group(n = 157)and VATS group(n = 239)according to different surgical methods.To determine the effect of surgical methods on the survival and recurrence-free survival of patients in the two groups,log-rank test and Cox regression model were used,and KaplanMeier curve was used to calculate and draw the survival curve.The survival difference and recurrence-free survival rate were compared between the two groups,and the influencing factors of prognosis were also studied.The clinical data of the patients were collected,including sex,age,smoking history,location of tumor lesions,transverse diameter of tumor,degree of tumor differentiation,pathological TNM stage,intraoperative blood loss,chest drainage volume at 24 hours and 48 hours after operation,postoperative catheterization time,the time of postoperative hospital stays,and the number of dissected lymph nodes during operation.Through the analysis of t test,chisquare test,log-rank test and Cox regression model,the influence of different surgical methods on the survival status of patients was analyzed and the influencing factors were analyzed.ResultsA total of 396 patients met the inclusion criteria,and the perioperative clinical data of RATS group and VATS group were statistically analyzed.It was found that the intraoperative blood loss [(48 ± 42)m L vs.(182 ± 231)m L,P < 0.001] and postoperative24-hour drainage volume [(250 ± 119)m L vs.(324 ± 208)m L,P < 0.001] were less in RATS group than in VATS group.The number of lymph node dissection groups in the RATS group versus the VATS group [(5 ± 2 group vs.3 ± 2 groups),P < 0.001] and the number of dissected [(17 ± 9 vs.11 ± 8),P < 0.001],and the RATS group was significantly better than the VATS group.There was no significant difference in postoperative 48 hours drainage volume(P = 0.497),postoperative intubation time(P = 0.180)and hospital stay(P = 0.313)between RATS group and VATS group.Comparison of overall survival and recurrence-free survival between the RATS and VATS groups showed that the survival rates of the two groups [1-year survival rate: 98.7% vs.94.8%,5-year survival rate: 90.5%vs.75.8%,8-year survival rate: 76.9% vs.62.1%,mean survival time:(93 months vs.79months),P = 0.005];recurrence-free survival: RATS group versus VATS group [1-year recurrence-free survival: 97.4% vs.95.6%,5-year recurrence-free survival: 94.8% vs.77.8%,8-year recurrence-free survival: 82.6% vs.64.8%,mean recurrence-free survival time:(95 months vs.79 months),P = 0.004],and the survival rate and recurrence-free survival rate in the RATS group were significantly better than those in the VATS group.Univariate analysis showed that surgical methods,the number of lymph node dissection groups and the number of lymph node dissection were the influencing factors of postoperative survival status and recurrence-free survival status of patients.At the same time,multivariate analysis showed that surgical approach was a common independent factor for survival status and recurrence-free survival status.Conclusion1.RATS can obtain better survival and recurrence-free survival in patients with stage I NSCLC.2.RATS has more thorough lymph node dissection,less intraoperative blood loss and postoperative 24-hour drainage volume.3.Univariate analysis showed that surgical methods,the number of lymph node dissection groups and the number of lymph node dissection were the influencing factors of postoperative survival status and recurrence-free survival status of patients.4.Multivariate analysis showed that surgical approach was a common independent factor for survival status and recurrence-free survival status.