| BackgroundLung cancer is the malignant tumor with both the highest incidence and mortality rate in the world and second only to stroke and coronary heart disease as the leading cause of death among Chinese population.Even though the choices of treatment for lung cancer tend to be more diversified,the prognoses of lung cancer patients remain extremely poor.However,early intervention of surgery for lung cancer can greatly reduce mortality and becomes the key to lung cancer treatment.Thoracoscopic assisted radical resection for lung cancer has been recognized by the majority of thoracic surgeons because of its fewer complications and less trauma compared with the traditional procedure of thoracotomy.The development of the Da Vinci robotic surgical system reflects the development direction of surgery.In 2002,the system was used for lung cancer surgery for the first time.So far,the advantages in terms of minimally invasiveness and safety of the Da Vinci surgical system have been reported internationally.However,the mixed bias of the sample,the lack of prospective comparison,and the ambiguous classification of variables have interfered the previous studies,a more standardized and systematic controlled trial is needed.ObjectiveTo compare the short-term outcomes and long-term survival of Da Vinci robot-assisted surgery with thoractomy and video-assisted thoracoscopic surgery in the treatment of lung cancer.MethodsThe clinical data of 102 patients who underwent Da Vinci robot-assisted lung cancer radical resection in the Department of Thoracic Surgery of the First Affiliated Hospital of Zhengzhou University from August 2016 to August 2019 were collected retrospectively.Another two groups of lung cancer patients receiving radical resection were matched with the nearest matching method by using Empower Stats,of whom102 patients received thoracotomy and 102 patients received thoracoscopic assisted surgery respectively.The covariates included gender,age,body mass index(BMI),American Society of Anesthesiologists(ASA)score,percentage of predicted forced expiratory volume in one second(FEV1%),tumor location,tumor maximum diameter,type and differentiation status of tumor and staging status.Intraoperative and postoperative indexes were recorded.The intraoperative indexes consisted of total operation time,intrathoracic operation time,intraoperative blood loss,whether receiving intraoperative blood transfusion,total number and stations of dissected lymph node.The postoperative indexes included volume of drainage 3 days after surgery,level of C-reactive protein(CRP)on the first and third day after surgery,time for drainage,postoperative complications,visual analog score(VAS)on the first and third day after surgery,whether receiving unplanned reoperation,nodal upstaging status,unplanned readmission within 1 month,deaths within 1 and 3 months.SPSS 22.0 statistical software was used to analyze the data.The measurement data met the normal distribution,which was expressed by mean ± SD,and two independent sample t-test was used for the comparison between groups.The counting data was expressed by frequency,Chi-square test and Fisher exact probability method were used for the comparison between groups,Mann-Whitney U test was used for the ranked data.Log rank test and Kaplan Meier method were used for survival analysis.P<0.05 was considered as statistically significant.ResultsCompared with thoracotomy for the treatment of lung cancer,the total intraoperative time of Da Vinci robot-assisted surgery was longer(151.10±11.12 min vs 131.15±8.22 min,P<0.05),the intraoperative blood loss was less(87.22±19.21 ml vs 189.74±47.87 ml,P<0.05),the total number of dissected lymph nodes was more(mediastinal: 8.83±1.68 vs 6.08±0.47,P<0.05;hilar and intrapulmonary: 9.54±1.58 vs 6.62±1.35,P<0.05),the volume of drainage was less(322.23±19.86 ml vs431.66±30.67 ml,P<0.05),the time for drainage was shorter(3.12±0.21 days vs4.79±0.68 days,P<0.05),the level of CRP after surgery was lower(on the first day:46.92±5.88 mg/L vs 61.30±5.20 mg/L,P<0.05;on the third day: 30.35±8.11 mg/L vs44.53±3.14 mg/L,P<0.05),the VAS score after surgery was lower(on the first day:1.87±0.44 vs 3.11±0.73,P<0.05;on the third day: 1.16±0.31 vs 2.68±0.45,P<0.05),and the incidence of postoperative complications was lower(P<0.05).However,the differences of the thoracic operation time(129.37±10.31 min vs 126.28±13.84 min,P>0.05),the number of dissected lymph node stations(mediastinal: 3.62±0.52 vs3.53±0.69,P>0.05;hilar and intrapulmonary: 2.31±0.48 vs 2.26±0.42,P>0.05),whether receiving intraoperative blood transfusion(P>0.05),whether receiving unplanned reoperation(P>0.05),the nodal upstaging status(P>0.05),the unplanned readmission within 1 month(P>0.05),the mortality within 1 and 3 month(P>0.05),the postoperative overall survival(Log Rank P>0.05),the progression-free survival(Log Rank P>0.05)were not statistically significant.Compared with thoracoscopic assisted surgery for the treatment of lung cancer,the total intraoperative time of Da Vinci robot-assisted surgery was longer(151.10±11.12 min vs 139.33 ± 9.66 min,P<0.05),the thoracic operation time was shorter(129.37±10.31 min vs 135.14±9.67 min,P<0.05),the intraoperative blood loss was less(87.22±19.21 ml vs 111.54±18.81 ml,P<0.05),the total number of dissected lymph nodes was more(mediastinal: 8.83±1.68 vs 6.13±0.73,P<0.05;hilar and intrapulmonary: 9.54±1.58 vs 7.17±1.97,P<0.05),the volume of drainage wasless(322.23±19.86 ml vs 361.72±21.24 ml,P<0.05),the level of CRP after surgery was lower(on the first day: 46.92±5.88 mg/L vs 55.38±6.11 mg/L,P<0.05;on the third day: 30.35±8.11 mg/L vs 39.70±7.32 mg/L,P<0.05),the VAS score on the first day after surgery was lower(1.87±0.44 vs 2.69±0.82,P<0.05).However,the differences of the VAS score on the third day after surgery(1.16±0.31 vs 1.24±0.47,P>0.05),the time for drainage(3.12±0.21 days vs 3.18±0.36 days,P>0.05),the number of dissected lymph node stations(mediastinal: 3.62±0.52 vs 3.49±0.57,P>0.05;hilar and intrapulmonary: 2.31±0.48 vs 2.20±0.53,P>0.05),whether receiving intraoperative blood transfusion(P>0.05),the incidence of postoperative complications(P>0.05),whether receiving unplanned reoperation(P>0.05),the nodal upstaging status(P>0.05),the unplanned readmission within 1 month(P>0.05),the mortality within 1 and 3 month(P>0.05),the postoperative overall survival(Log Rank P>0.05),the progression-free survival(Log Rank P>0.05)were not statistically significant.Conclusion1.Da Vinci robot-assisted lung cancer surgery is safe and feasible,not only can it achieve the similar radical effect of thoracotomy or thoracoscopic surgery,but also has advantages in intraoperative lymph node dissection,bleeding control,postoperative trauma and rapid recovery.2.The progression-free survival and the overall survival for lung cancer patients after Da Vinci robotic surgery are not different from that of those receiving thoracotomy or thoracoscopic surgery.3.Da Vinci robotic surgery takes longer,however,the prolonging surgical time does not increase the risk of complications.4.There is no statistical difference in the nodal upstaging status among these surgical treatments,and high-quality lymph node evaluation can be achieved. |
