Dataset Information

Short- and long-term outcomes of robotic-assisted versus video-assisted thoracoscopic lobectomy in non-small cell lung cancer patients aged 35 years or younger: a real-world study with propensity score-matched analysis.

ABSTRACT:

Purpose

This study compared short- and long-term outcomes of robotic-assisted thoracoscopic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for lobectomy in young adults aged ≤ 35 years with non-small cell lung cancer (NSCLC), aiming to assess the superiority of RATS over VATS for this special group of patients.

Methods

A total of 1355 consecutive NSCLC cases aged 18-35 years undergoing RATS (n = 105) or VATS (n = 1250) between 2014 and 2021 were retrospectively identified from a prospectively maintained database. Propensity score matching (PSM) was applied to establish a 1:3 RATS versus VATS ratio. Baseline clinicopathological characteristics, perioperative outcomes, lymph node (LN) assessment, and long-term survival were investigated.

Results

Following PSM, 105 and 315 cases were in the RATS and VATS groups, respectively. RATS led to a shorter postoperative hospital stay than VATS (4.0 ± 1.5 vs 4.3 ± 1.7 days, p = 0.02). The two groups were comparable in other perioperative outcomes and postoperative complications (all p > 0.05). Moreover, RATS assessed more LNs (9.4 ± 4.4 vs 8.3 ± 3.6, p = 0.03), especially N1 LNs (4.2 ± 3.1 vs 3.5 ± 2.2, p = 0.02), than VATS. By comparison, no difference in 5-year recurrence-free survival (RFS), overall survival (OS), or recurrence or mortality patterns was found between the two groups (all p > 0.05). Further subgroup analyses also observed similar long-term outcomes between the two groups regarding age, gender, and smoking history. Finally, Cox's analyses found that the surgical approach was not independently correlated with RFS or OS.

Conclusion

RATS shortened postoperative hospital stay, assessed more N1 and total LNs, and achieved comparable long-term outcomes to VATS for very young NSCLC patients.

SUBMITTER: Pan H

PROVIDER: S-EPMC10423161 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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Publications

Short- and long-term outcomes of robotic-assisted versus video-assisted thoracoscopic lobectomy in non-small cell lung cancer patients aged 35 years or younger: a real-world study with propensity score-matched analysis.

Pan Hanbo H Zhang Jiaqi J Tian Yu Y Zou Ningyuan N Zhu Hongda H Gu Zenan Z Jin Weiqiu W Ning Junwei J Jiang Long L Huang Jia J Luo Qingquan Q

Journal of cancer research and clinical oncology 20230530 12

<h4>Purpose</h4>This study compared short- and long-term outcomes of robotic-assisted thoracoscopic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for lobectomy in young adults aged ≤ 35 years with non-small cell lung cancer (NSCLC), aiming to assess the superiority of RATS over VATS for this special group of patients.<h4>Methods</h4>A total of 1355 consecutive NSCLC cases aged 18-35 years undergoing RATS (n = 105) or VATS (n = 1250) between 2014 and 2021 were retrospectively ...[more]

PMID: 37253947

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Project description:IntroductionAlthough robot-assisted thoracoscopic surgery (RATS) has been widely applied in treating non-small cell lung cancer (NSCLC), its advantages remain unclear for very old patients. The present study compared the perioperative outcomes and survival profiles among RATS, video-assisted thoracoscopic surgery (VATS), and open lobectomy (OL), aiming to access the superiority of RATS for NSCLC patients aged ≥75 years.MethodsPathological IA-IIIB NSCLC patients aged ≥75 years who underwent RATS, VATS, or OL between June 2015 and June 2021 in Shanghai Chest Hospital were included. Propensity score matching (PSM, 1:1:1 RATS versus VATS versus OL) was based on 10 key prognostic factors. The primary endpoints were perioperative outcomes, and the secondary endpoints were disease-free (DFS), overall (OS), and cancer-specific survival (CS).ResultsA total of 504 cases (126 RATS, 200 VATS, and 178 OL) were enrolled, and PSM led to 97 cases in each group. The results showed that RATS led to: 1) the best surgical-related outcomes including the shortest operation duration (p <0.001) and the least blood loss (p <0.001); 2) the fastest postoperative recoveries including the shortest ICU stay (p = 0.004), chest tube drainage duration (p <0.001), and postoperative stay (p <0.001), and the most overall costs (p <0.001); 3) the lowest incidence of postoperative complications (p = 0.002), especially pneumonia (p <0.001). There was no difference in the resection margins, reoperation rates, intraoperative blood transfusion, and volume of chest tube drainage among the three groups. Moreover, RATS assessed more N1 (p = 0.009) and total (p = 0.007) lymph nodes (LNs) than VATS, while the three surgical approaches dissected similar numbers of N1, N2, and total LN stations and led to a comparable incidence of postoperative nodal upstaging. Finally, the three groups possessed comparable DFS, OS, and CS rates. Further subgroup analysis found no difference in DFS or OS among the three groups, and multivariable analysis showed that the surgical approach was not independently correlated with survival profiles.ConclusionRATS possessed the superiority in achieving better perioperative outcomes over VATS and OL in very old NSCLC patients, though the three surgical approaches achieved comparable survival outcomes.

Project description:BackgroundEnhanced recovery pathways or fast-tracking following surgery can decrease the rate of postoperative complications and hospital length of stay. The objectives of this study were to implement an enhanced recovery after surgery (ERAS) pathway for patients undergoing a video-assisted thoracoscopic surgery (VATS) lobectomy, to assess the safety and efficiency of this protocol by measuring associated postoperative outcomes, and to compare the outcomes for patients in the ERAS group with the outcomes for patients in a propensity-matched control group.MethodsThe study was a prospective clinical trial. Patients who were scheduled to undergo VATS lobectomy at the Centre hospitalier de l'Université de Montréal in Montréal, Quebec, Canada, were enrolled between November 2015 and October 2016. The ERAS pathway was used for all enrolled patients. The primary outcome was the number and severity of complications measured by the Comprehensive Complication Index. Secondary outcomes included length of stay, readmission and recovery. Recovery of patients was measured using EQ-5D-5L preoperatively and at 1 week, 1 month and 4 months after surgery. Prospectively enrolled patients were propensity matched to historical controls.ResultsNinety-eight patients (36 men and 62 women) in the ERAS group and 98 patients in the control group (29 men and 69 women) were included in the analysis. The mean age was 65.2 ± 9.3 years, the mean body mass index (BMI) was 26.9 ± 5.9 kg/m2 and the median Charlson Comorbidity Index score was 2 (interquartile range [IQR] 2-3) in the ERAS group. In the control group, the mean age was 66.2 ± 9.4 years, the mean BMI was 27.4 ± 5.6 kg/m2 and the median Charlson Comorbidity Index score was 3 (IQR 2-3). A total of 23 patients (23.4%) in the ERAS group and 28 (28.6%) in the control group experienced 1 or more postoperative complications. The mean Comprehensive Complication Index score was 7.4 ± 16.8 in the ERAS group compared with 8.0 ± 14.3 in the control group (p = 0.79). The median postoperative length of stay was 3 days in the ERAS group and 5 days in the control group (p < 0.001). Five patients in the ERAS group and 4 patients in the control group were readmitted. The protocol adherence rate was 64.3%.ConclusionIt is feasible to implement an enhanced recovery protocol after VATS lobectomy. Although the pathway is still early in its development in Canada, implementation of an ERAS pathway after VATS lobectomy was associated with decreased length of stay, with no observable increase in complication or readmission rates.

Project description:ObjectivesThe aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy.MethodsFrom December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score-matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan-Meier and competing risks method were used to compare survival.ResultsIn the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83; P = .002), lower postoperative prolonged air leak (relative risk, 0.42; 95% confidence interval, 0.23-0.78; P = .003), and shorter median postoperative stay (4.8 vs 6.2 days; P = .004) than video-assisted thoracic surgery lobectomy. After propensity score-matched analysis, prolonged air leak remained significantly lower in video-assisted thoracic surgery anatomic segmentectomy (relative risk, 0.33; 95% confidence interval, 0.12-0.89; P = .02). Kaplan-Meier and competing risk curves showed no differences during the 3-year follow-up (median follow-up in months: 24.4; interquartile range, 20.8-28.3) in terms of overall survival (hazard ratio, 0.73; 95% confidence interval, 0.45-1.7; P = .2), tumor progression-related mortality (subdistribution hazard ratio, 0.41; 95% confidence interval, 0.11-1.57; P = .2), and disease-free survival (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.35-1.51; P = .4) between groups.ConclusionsVideo-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.

Project description:BackgroundPersonalized three-dimensional (3D) reconstruction can help surgeons to overcome technical challenges and variations of pulmonary anatomic structures in the performance of uniportal video-assisted thoracoscopic surgery (UVATS), thus improving the safety and efficacy of the procedure. This study aims to evaluate the utility of preoperative 3D-CT bronchography and angiography (3D-CTBA) with Exoview software in the assessment of anatomical variations of pulmonary vessels, and to analyze short-term surgical outcomes in patients undergoing UVATS lobectomy.MethodsWe retrospectively analyzed the data of 198 consecutive patients who underwent curative UVATS lobectomy between November 2019 and September 2020. The patients were divided into an "Exoview" group (n=53) and a "non-Exoview" group (n=145). We performed 1:1 propensity score matching and compared intraoperative and postoperative outcomes between the two groups. A subgroup analysis of 74 patients who underwent single-direction uniportal lobectomy was also conducted. Aberrant pulmonary vessel patterns related to the surgery were also examined.ResultsThe operative time in the Exoview group was significantly shorter than that in the non-Exoview group, both before (145.7±33.9 vs. 159.5±41.6 minutes, P=0.032) and after (145.7±33.9 vs. 164.2±41.8 minutes, P=0.014) propensity score matching. The number of mediastinal lymph nodes dissected was higher in the Exoview group than in the non-Exoview group (8.19±6.89 vs. 5.78±3.3, P=0.024) after propensity score matching. Intraoperative blood loss showed a statistical difference between the Exoview and non-Exoview groups (60.4±45.4 vs. 100.8±83.9, P=0.009). Four types of arterial variations and 2 types of venous variations related to the surgery were observed among 8 patients (15%), which have rarely been reported before.ConclusionsPersonalized preoperative 3D-CT bronchography and angiography helped to clearly visualize the pulmonary anatomical structures and could contribute to the safe and efficient performance of UVATS anatomical lobectomy.

Project description:BACKGROUND:In recent years, the technique of uniportal video-assisted thoracoscopic surgery has been developed. As a new surgical method, its feasibility and safety have not been generally recognized. The aim of this study is to review the technology in the treatment of lung cancer patients in stage I to part of stage IIIa. METHODS:The clinical data of patients accepted thoracoscopic resection of lung cancer by a same medical group from May 2018 to March 2019 in The First Affiliated Hospital of Soochow University were retrospectively analyzed. After remove of cases that did not meet the requirements, the patients were divided into uniportal group (55 cases) and biportal group (87 cases). The clinical data of the two groups were collected and statistically analyzed. RESULTS:All the 142 patients underwent lobectomy and systemic lymph node dissection. There is no perioperative death in both groups. There was no significant difference in age, location of tumors, pathological type, size of tumors and pathological tumor-node-metastasis (pTNM) staging between uniportal group and biportal group (P>0.05). The operation time [(167.65±43.85) min vs (181.71±51.28) min], the intraoperative bleeding volume [(57.45±50.19) mL vs (87.47±132.54) mL], the indwelling time of drainage tube [(4.82±2.82) d vs (5.84±3.43) d] and the hospital stay [(6.91±3.88) d vs (7.74±3.87) d] were less in uiportal group compared to biportal group, though no significant difference occurred (P>0.05 ). The total drainage volume of uniportal group was significantly lower than that of biportal group [(1,064.82±776.38) mL vs (1,658.71±1,722.38) mL], and the visual analogue score of 24 hours and 72 hours after operation [(4.73±0.73) points vs (5.25±0.74) points; (2.16±0.71) points vs (2.55±0.86) points] were lower in uniportal group (P<0.05). CONCLUSIONS:Uniportal video-assisted thoracoscopic radical resection of lung cancer is safe and feasible for stage I to part of stage IIIa lung cancer patients.

Dataset Information

Short- and long-term outcomes of robotic-assisted versus video-assisted thoracoscopic lobectomy in non-small cell lung cancer patients aged 35 years or younger: a real-world study with propensity score-matched analysis.

Purpose

Methods

Results

Conclusion

Publications

Short- and long-term outcomes of robotic-assisted versus video-assisted thoracoscopic lobectomy in non-small cell lung cancer patients aged 35 years or younger: a real-world study with propensity score-matched analysis.

Similar Datasets

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