Comparison of medium-term survival outcomes between robot-assisted thoracoscopic surgery and video-assisted thoracoscopi
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ORIGINAL ARTICLE
Comparison of medium‑term survival outcomes between robot‑assisted thoracoscopic surgery and video‑assisted thoracoscopic surgery in treating primary lung cancer Tomohiro Haruki1 · Yasuaki Kubouchi1 · Yuzo Takagi1 · Yoshiteru Kidokoro1 · Shinji Matsui1 · Atsuyuki Nakanishi1 · Ken Miwa1 · Yuji Taniguchi1 · Hiroshige Nakamura1 Received: 7 November 2019 / Accepted: 1 February 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objectives Robot-assisted thoracoscopic surgery (RATS) for primary lung cancer has been spreading rapidly in Japan. While RATS has various technical advantages over video-assisted thoracoscopic surgery (VATS), the quality of surgery from an oncologic viewpoint must be maintained, and the evaluation of medium- to long-term survival outcomes is momentous. Methods This study included 299 patients with primary lung cancer (VATS, n = 246; RATS, n = 53) who underwent lobectomy and mediastinal lymph node dissection at our hospital. We reviewed and compared perioperative factors, the number of dissected lymph nodes, and postoperative recurrence between the VATS and RATS groups. We also compared the postoperative survival rates among 98 patients (49 patients in each group) whose background factors were adjusted by propensity score matching (PSM). Results After PSM, a significant difference was found in the total operative time between the two groups (p 1.0 cm on chest CT and
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General Thoracic and Cardiovascular Surgery
with FDG uptake on positron emission tomography/CT were clinically suspected to be positive for lymph node metastasis. Additional examinations included standard hematology and chemistry panel studies, arterial blood gas analysis, electrocardiogram, and pulmonary function testing. Because the clinical and pathological stages were determined according to the 6th and 7th Editions of the TNM classification in the initial period of this study, those cases were restaged according to the 8th Edition of the TNM classification for the present study. The severity of surgical complications was graded according to the Clavien–Dindo classification system [7], and postoperative complications with a Clavien–Dindo classification grade of ≥ 2 were considered clinically significant in this study.
Surgical procedure All patients underwent standard general anesthesia with single-lung ventilation using a double-lumen endotracheal tube. The patient was placed in the lateral decubitus position. VATS was performed using previously described techniques [8]. Briefly, the procedure was performed through a 3 cm access incision and three thoracostomy ports were completely under thoracoscopic visualization. The hilar structures were individually ligated by endoscopic staplers. Small blood vessels were sealed and cut mostly by a vessel-sealing device. RATS was also performed using previously described settings and techniques [9]. The platforms employed were the da Vinci second- and third-generation systems (da Vinci S and Si, respectively; Intuitive Surgical Inc.). The robotic
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