Die Ergebnisse der RATS und VATS bei anatomischen Resektionen in der Anfangsphase

Zusammenfassung

Zielsetzung

Die robotergestützte (RATS) anatomische Resektion ist eine neue, aber wegen ihrer Kosten umstrittene Methode in der Behandlung von Lungentumoren. Das Ziel unserer retrospektiven Studie war der Vergleich klinischer Daten der anatomischen RATS- und VATS-Resektionen.

Methodik

Die ersten 100 VATS- und RATS-Resektionen wurden hinsichtlich Tumorstadium, intra- und postoperativer Komplikationen, Konversion, OP-Zeit, Krankenhausaufenthalt und Länge der Drainagebehandlung, postoperativer Schmerzen (numerische Rating-Skala NRS) und Letalität analysiert. Die Ergebnisse wurden mit Chi-Quadrat-, Fisher- und unabhängigem t-Test verglichen.

Ergebnisse

In der VATS-Gruppe war das Stadium I häufiger, das Stadium II seltener (St. I: 73,4%; St. II: 19,2%) als in der RATS-Gruppe (St. I: 65,5%; St. II. 23%; p = 0,695). Die OP-Zeit war bei RATS länger (213,5 min vs. 190,3 min; p = 0,008), bedingt durch die An- und Abdockzeiten des Robotersystems an den Patienten. In der RATS-Gruppe war die Rate der sublobären Resektionen signifikant höher (28% vs. 7%; p < 0,001). Der Anteil intraoperativer Komplikationen (7% vs. 14%; p = 0,073) und die Konversionsrate (9% vs. 11%; p = 0,407) waren niedriger bei den RATS-Operationen. Die Anzahl der entfernten Lymphknoten war in beiden Gruppen hoch, jedoch nicht signifikant unterschiedlich (VATS: 21,6; RATS: 22,1). Der Krankenhausaufenthalt war kürzer nach RATS (8,8 Tage) als nach VATS (12,5 Tage; p < 0,001), ebenso die Länge der postoperativen Drainagebehandlung (5,6 vs. 8 Tage; p < 0,001). In der RATS-Gruppe waren die postoperativen Schmerzen am 1. und 2. postoperativen Tag deutlich niedriger ermittelt anhand der numerischen Rating-Skala (1,68 vs. 2,83; p < 0,001; 0,99 vs. 2,41; p < 0,001). Nach VATS war die Komplikationsrate signifikant höher als nach RATS (57% vs. 33%; p = 0,001), ebenso gab es weniger Reoperationen in der RATS- (3%) im Vergleich zur VATS-Gruppe (8%; p = 0,121). In VATS-Gruppe starben 4 Patienten, nach RATS kein Patient (p = 0,043).

Schlussfolgerung

Die robotergestützte Technik ermöglicht anatomische Resektionen zur Entfernung von Lungentumoren, bei geringerer Konversions- und Komplikationsrate bzw. Letalität sowie geringeren postoperativen Schmerzen. Die Roboteroperationen zeigen sich somit als sicher und onkologisch vergleichbar mit den anatomischen VATS-Resektionen bei Lungenkarzinom.

Abstract

Objective

Robot-assisted (RATS) anatomical resection is a new method in the treatment of lung tumours, but is controversial due to its cost. The aim of our retrospective study was to compare the clinical results of the RATS and VATS anatomical resections.

Methods

The first 100 VATS and RATS resections were analysed with regard to tumour stage, intra- and postoperative complications, conversion, operation time, hospital stay and length of drainage treatment, postoperative pain (numerical rating scale, NRS) and mortality. The results were compared using the chi-square, Fisher and independent t tests.

Results

In the VATS group, stage I was more frequent, stage II less frequent (stage I: 73.4%, stage II: 19.2%) than in the RATS group (stage I: 65.5%, stage II. 23%, p = 0.695). The operating time was longer with RATS (213.5 min vs. 190.3 min, p = 0.008), due to the docking and undocking time of the robotic system to the patient. The proportion of sublobar resections was significantly higher in the RATS group (28% vs. 7%, p < 0.001). The proportion of intraoperative complications (7% vs. 14%, p = 0.073) and conversion rate (9% vs. 11%, p = 0.407) were lower in the RATS surgery. The number of lymph nodes removed was high in both groups and not significantly different (VATS: 21.6, RATS: 22.1). The hospital stay was shorter after RATS (8.8 days) than after VATS (12.5 days, p < 0.001), as was the length of postoperative drainage treatment (5.6 vs. 8 days, p < 0.001). In the RATS group, postoperative pain on the 1st and 2nd postoperative day was significantly lower, as based on the numeric rating scale (1.68 vs. 2.83, p < 0.001, 0.99 vs. 2.41, p < 0.001). The complication rate was significantly higher after VATS than after RATS (57% vs. 33%, p = 0.001), and fewer reoperations were necessary after RATS (3%) than in the VATS group (8%, p = 0.121). Four patients died in the VATS group, none after RATS (p = 0.043).

Conclusion

The robot-assisted technique enables anatomical resections with lower conversion, complication rates and mortality, as well as less postoperative pain. Robotic surgery has proven to be safe and oncologically comparable to anatomical VATS resections for lung cancer.

Schlüsselwörter

RATS - anatomische Lungenresektion - Komplikation - VATS

Keywords

RATS - major lung resection - complication - VATS

Publication History

Received: 22 April 2024

Accepted after revision: 23 June 2024

Article published online:
05 February 2025

• Literatur

• 1 Paul S, Altorki NK, Sheng S. et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: A propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg 2010; 139: 366-378
• 2 Petersen RP, Pham D, Burfeind WR. et al. Thoracoscopic Lobectomy Facilitates the Delivery of Chemotherapy after Resection for Lung Cancer. Ann Thorac Surg 2007; 83: 1245-1250
• 3 FloresMFPark BJ, Dycoco J. et al. Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer. J Thorac Cardiovasc Surg 2009; 138: 11-18
• 4 Dylewski MR, Lazzaro RS. Robotics – The answer to the Achilles’ heel of VATS pulmonary resection. ChinJ Cancer Res 2012; 24: 259-260
• 5 Deen SA, Wilson JL, Wilshire CL. et al. Defining the Cost of Care for Lobectomy and Segmentectomy: A Comparison of Open, Video-Assisted Thoracoscopic, and Robotic Approaches. Ann Thorac Surg 2014; 97: 1000-1007
• 6 Subramanian MP, Liu J, Chapman WC. Utilization Trends, Outcomes, and Cost in Minimally Invasive Lobectomy. Ann Thorac Surg 2019; 108: 1648-1655
• 7 Paul S, Jalbert J, Isaacs AJ. Comparative Effectiveness of Robotic-Assisted vs Thoracoscopic Lobectomy. Chest 2014; 146: 1505-1512
• 8 Guo F, Ma D, Li S. Compare the prognosis of Da Vinci robot-assisted thoracic surgery (RATS) with video-assisted thoracic surgery (VATS) for non-small cell lung cancer. Medicine 2019; 98: 39
• 9 Zhang L, Li M, Yin R. et al. Comparison of the Oncologic Outcomes of Anatomic Segmentectomy and Lobectomy for Early-Stage Non-Small Cell Lung Cancer. Ann Thorac Surg 2015; 99: 728-737
• 10 Berry MF, D’Amico TA, Onaitis MW. et al. Thoracoscopic Approach to Lobectomy for Lung Cancer Does Not Compromise Oncologic Efficacy. Ann Thorac Surg 2014; 98: 197-202
• 11 Kent MS, Hartwig MG, MDVallières E. et al. Pulmonary Open, Robotic, and Thoracoscopic Lobectomy (PORTaL) Study An Analysis of 5721 Cases. Ann Surg 2023; 277: 528-533
• 12 Jin R, Zheng Y, Yuan Y. et al. Robotic-assisted Versus Video-assisted Thoracoscopic Lobectomy. Short-term Results of a Randomized Clinical Trial (RVlob Trial). Ann Surg 2022; 275: 295-302
• 13 Patel Y, Baste JM, Shargall Y. et al. Robotic Lobectomy Is Cost-effective and Provides Comparable Health Utility Scores to Video-assisted Lobectomy. Early Results of the RAVAL Trial. Ann Surg 2023; 278: 841-849
• 14 Veronesi G, Abbas AE, Muriana P. et al. Perioperative Outcome of Robotic Approach Versus Manual Videothoracoscopic Major Resection in Patients Affected by Early Lung Cancer: Results of a Randomized Multicentric Study (ROMAN Study). Front Oncol 2021; 11: 726408
• 15 Herrera LJ, Schumacher LY, Hartwig MG. et al. Pulmonary Open, Robotic, and Thoracoscopic Lobectomy study: Outcomes and risk factors of conversion during minimally invasive lobectomy. J Thorac Cardiovasc Surg 2023; 166: 251-262
• 16 Cheufou DH, Mardanzai K, Ploenes T. et al. Effectiveness of Robotic Lobectomy—Outcome and Learning Curve in a High Volume Center. Thorac Cardiovasc Surg 2019; 67: 573-577
• 17 Pan H, Gu Z, Tian Y. et al. Propensity score-matched comparison of robotic- and video-assisted thoracoscopic surgery, and open lobectomy for non-small cell lung cancer patients aged 75 years or older. Front Oncol 2022; 12: 1009298
• 18 Toker A, Özyurtkan MO, Demirhan Ö. et al. Lymph Node Dissection in Surgery for Lung Cancer: Comparison of Open vs. Video-Assisted vs. Robotic-Assisted Approaches. Ann Thorac Cardiovasc Surg 2016; 22: 284-290
• 19 Casiraghi M, Mariolo AV, Mohamed S. et al. Long-Term Outcomes of Robotic-Assisted, Video-Assisted and Open Surgery in Non-Small Cell Lung Cancer: A Matched Analysis. J Clin Med 2022; 11: 3363-3375
• 20 Zhiqiang W, Shaohua M. Perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic lobectomy: A propensity score matched analysis. Thorac Cancer 2023; 14: 1921-1931
• 21 Oh DS, Reddy RM, Gorrepati ML. et al. Robotic-Assisted, Video-Assisted Thoracoscopic and Open Lobectomy: Propensity-Matched Analysis of Recent Premier Data. Ann Thorac Surg 2017; 104: 1733-1740
• 22 Louie BE, Wilson JL, Kim S. et al. Comparison of Video-Assisted Thoracoscopic Surgery and Robotic Approaches for Clinical Stage I and Stage II Non-Small Cell Lung Cancer Using The Society of Thoracic Surgeons Database. Ann Thorac Surg 2016; 102: 917-924
• 23 Eichhorn M, Bernauer E, Rotärmel A. et al. Clinical effectiveness of robotic-assisted compared to open or video-assisted lobectomy in Germany: a real-world data analysis. Interdiscip Cardiovasc Thorac Surg 2024; 38: ivae001
• 24 Novellis P, Bottoni E, Voulaz E. et al. Robotic surgery, video-assisted thoracic surgery, and open surgery for early stage lung cancer: comparison of costs and outcomes at a single institute. J Thorac Dis 2018; 10: 790-798
• 25 Catelli C, Corzani R, Zanfrini E. et al. RoboticAssisted (RATS) versus Video-Assisted (VATS) lobectomy: A monocentric prospective randomized trial. Eur J Surg Oncol 2023; 49: 107256
• 26 Terra RM, Araujo PHXN, Lauricella LL. et al. A Brazilian randomized study: Robotic-Assisted vs. Video-assisted lung lobectomy Outcomes (BRAVO trial). J Bras Pneumol 2022; 48: e20210464
• 27 Asemota N, Maraschi A, Lampridis S. et al. Comparison of Quality of Life after Robotic, Video-Assisted, and Open Surgery for Lung Cancer. J Clin Med 2023; 12: 6230
• 28 Park BJ, Melfi F, Mussi A. et al. Robotic lobectomy for non–small cell lung cancer (NSCLC): Long-term oncologic results. J Thorac Cardiovasc Surg 2012; 143: 383-389
• 29 Cerfolio RJ, Ghanim AF, Dylewski MR. et al. The long-term survival of robotic lobectomy for non–small cell lung cancer: A multi-institutional study. J Thorac Cardiovasc Surg 2018; 155: 778-786
• 30 Sesti J, Langan RC, Bell J. et al. A Comparative Analysis of Long-Term Survival of Robotic Versus Thoracoscopic Lobectomy. Ann Thorac Surg 2020; 110: 1139-1146
• 31 Kneuertz PJ, Singer E, D’Souza DM. et al. Hospital cost and clinical effectiveness of robotic-assisted versus video-assisted thoracoscopic and open lobectomy: A propensity score–weighted comparison. J Thorac Cardiovasc Surg 2019; 157: 2018-2206
• 32 Verma A, Hadaya J, Richardson S. et al. The Presence of a Cost-Volume Relationship in Robotic-assisted Thoracoscopic Lung Resections. Ann Surg 2023; 278: e377-e381
• 33 Augustin F, Bodner J, Maier H. et al. Robotic-assisted minimally invasive vs. thoracoscopic lung lobectomy: comparison of perioperative results in a learning curve setting. Langenbecks Arch Surg 2013; 398: 895-901
• 34 Eichhorn M, Rotärmel A, Haag J. et al. Robot-assisted Thoracic Surgery: Learning Curve and Cost Analysis in a German High-Volume Centre. Zentralbl Chir 2023; 148: 26-32