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BACKGROUND: Robotic-assisted thoracic surgery (RATS) has been widely used in the treatment of lung cancer. The perioperative outcomes of right upper lobectomy (RUL) using RATS and video-assisted thoracic surgery (VATS) were retrospectively investigated and compared. We aimed to summarize a single-center experience of RATS and 4-port unidirectional VATS in RUL, and to discuss the safety and the essentials of the surgery. METHODS: We retrospectively analyzed the 685 with non-small cell lung cancer (NSCLC) patients who underwent minimally invasive RUL in our center by the same surgical group from January 2015 to December 2019. Both RATS and VATS were performed with three ports with utility incision. The 685 participants were divided into RATS (335 cases) and VATS (350 cases) groups according to surgical method. Baseline characteristics and perioperative outcomes including dissected lymph nodes, postoperative duration of drainage, postoperative hospital stay, and incidence of postoperative complications were compared between the groups. RESULTS: In the 685 patients enrolled, the baseline characteristics were comparable, and no postoperative 30-day mortality or intraoperative blood transfusion were observed. Compared with VATS, RATS had less surgical duration (90.22±12.16 vs. 92.68±12.26 min, P<0.001), less length of stay (4.71±1.37 vs. 5.26±1.56 days, P<0.001), and decreased postoperative duration of drainage (3.49±1.15 vs. 4.09±1.57 days, P<0.001). No significant difference was observed in the lymph nodes dissection, blood loss, conversion rate and morbidities. The cost of RATS was much higher than VATS (85,329.41±12,893.44 vs. 68,733.43±14,781.32 CNY, P<0.001). CONCLUSIONS: Robot assisted RUL had similar perioperative outcomes compared to VATS RUL lobectomy using similar three port with utility incision technique. The advantages of RATS included finer dissection of lymph node, relatively less operation time, earlier chest tube removal and discharge.
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BACKGROUND: Robotic thoracoscopic surgery was first done in mainland China in 2009 and has gained popularity in the past few years. Here, we present the largest Chinese series of robotic lobectomy for early-stage non-small cell lung cancer (NSCLC) to date. We aimed to compare the perioperative outcomes of our three-arm robotic-assisted lobectomy (RAL3) and video-assisted lobectomy (VAL) for p-stage I NSCLC and report the approach of the robotic anatomic lobar resections of our center. METHODS: We retrospectively collected and analyzed the data of 1075 stage I NSCLC patients who underwent minimally invasive lobectomies (237 RAL3 cases and 838 VAL cases) by the same surgical team from May 2013 to April 2016. Propensity score matching (PSM) was used to minimize the bias between the two groups. Perioperative outcomes were analyzed. RESULTS: Compared to the VALs, the RAL3s had more retrieved lymph nodes (LNs) (9.70 vs. 8.45, P=0.000), less POD1 drain (230.91 vs. 279.79 mL, P=0.001), shorter chest tube duration (3.84 vs. 4.33 d, P=0.003) and shorter postoperative length of stay (4.97 vs. 5.45 d, P=0.004), but a higher cost (¥93,244.84 vs. ¥67,055.82, P=0.000). No significant difference was observed between the RAL3 and VAL groups concerning the average skin-to-skin time (90.84 vs. 92.25 min, P=0.624), conversion rate (1.3% vs. 0.87%, P=1.000) and prolonged postoperative hospital stay (PPHS) rate (3.0% vs. 4.3%, P=0.694). CONCLUSIONS: This study confirms that RAL3 is a safer and more effective technique than VAL for the treatment of early-stage NSCLC.
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BACKGROUND: To investigate the potential value of CT parameters to differentiate ground-glass nodules between noninvasive adenocarcinoma and invasive pulmonary adenocarcinoma (IPA) as defined by IASLC/ATS/ERS classification. METHODS: We retrospectively reviewed 211 patients with pathologically proved stage 0-IA lung adenocarcinoma which appeared as subsolid nodules, from January 2012 to January 2013 including 137 pure ground glass nodules (pGGNs) and 74 part-solid nodules (PSNs). Pathological data was classified under the 2011 IASLC/ATS/ERS classification. Both quantitative and qualitative CT parameters were used to determine the tumor invasiveness between noninvasive adenocarcinomas and IPAs. RESULTS: There were 154 noninvasive adenocarcinomas and 57 IPAs. In pGGNs, CT size and area, one-dimensional mean CT value and bubble lucency were significantly different between noninvasive adenocarcinomas and IPAs on univariate analysis. Multivariate regression and ROC analysis revealed that CT size and one-dimensional mean CT value were predictive of noninvasive adenocarcinomas compared to IPAs. Optimal cutoff value was 13.60 mm (sensitivity, 75.0%; specificity, 99.6%), and -583.60 HU (sensitivity, 68.8%; specificity, 66.9%). In PSNs, there were significant differences in CT size and area, solid component area, solid proportion, one-dimensional mean and maximum CT value, three-dimensional (3D) mean CT value between noninvasive adenocarcinomas and IPAs on univariate analysis. Multivariate and ROC analysis showed that CT size and 3D mean CT value were significantly differentiators. Optimal cutoff value was 19.64 mm (sensitivity, 53.7%; specificity, 93.9%), -571.63 HU (sensitivity, 85.4%; specificity, 75.8%). CONCLUSIONS: For pGGNs, CT size and one-dimensional mean CT value are determinants for tumor invasiveness. For PSNs, tumor invasiveness can be predicted by CT size and 3D mean CT value.
