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

Pan, Hanbo; Tian, Yu; Jiang, Long; Zhu, Hongda; Ning, Junwei; Huang, Jia; Luo, Qingquan

doi:10.3389/fonc.2022.1009298

Cited by 17 publications

(29 citation statements)

References 41 publications

(27 reference statements)

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“…Indeed, the result of the sensitivity analysis showed no substantive differences when compared with the primary analysis in terms of pain score at 24 h and morphine equivalent consumption at 48 h. Differently from the primary analysis, the sensitivity analysis conducted using only studies with minimally invasive surgical technique and excluding the Davine, investigation [ 19 ] in which less than 20% of patients received a thoracotomy, showed a trend to a shorter LOS in favor of OFA. It is reasonable that, as the minimally invasive settings are associated with lower inpatient stay than an open approach [ 34 ], further decrease of LOS is hard to achieve by pharmacological protocols. In practice, the surgical technique affects LOS much more than the pharmacological strategies.…”

Section: Discussionmentioning

confidence: 99%

Opioid Free Anesthesia in Thoracic Surgery: A Systematic Review and Meta Analysis

D’Amico

Barucco

Licheri

et al. 2022

JCM

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Introduction: Recent studies showed that balanced opioid-free anesthesia is feasible and desirable in several surgical settings. However, in thoracic surgery, scientific evidence is still lacking. Thus, we conducted the first systematic review and meta-analysis of opioid-free anesthesia in this field. Methods: The primary outcome was the occurrence of any complication. Secondary outcomes were the length of hospital stay, recovery room length of stay, postoperative pain at 24 and 48 h, and morphine equivalent consumption at 48 h. Results: Out of 375 potentially relevant articles, 6 studies (1 randomized controlled trial and 5 observational cohort studies) counting a total of 904 patients were included. Opioid-free anesthesia compared to opioid-based anesthesia, was associated with a lower rate of any complication (74 of 175 [42%] vs. 200 of 294 [68%]; RR = 0.76; 95% CI, 0.65–0.89; p < 0.001; I2 = 0%), lower 48 h morphine equivalent consumption (MD −14.5 [−29.17/−0.22]; p = 0.05; I2 = 95%) and lower pain at 48 h (MD −1.95 [−3.6/0.3]; p = 0.02, I = 98%). Conclusions: Opioid-free anesthesia in thoracic surgery is associated with lower postoperative complications, and less opioid demand with better postoperative analgesia at 48 h compared to opioid-based anesthesia.

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Section: Discussionmentioning

confidence: 99%

Opioid Free Anesthesia in Thoracic Surgery: A Systematic Review and Meta Analysis

D’Amico

Barucco

Licheri

et al. 2022

JCM

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“…More specifically, the advantages of robotic surgery have been widely investigated in the recent past; nowadays, robotic lobectomy represents the gold standard in the treatment of early lung cancer, being feasible and safe, with clinical outcomes similar, or in some cases superior, to those of video-assisted thoracoscopic or open surgery [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…At present, robotic lobectomy is considered an achievable and safe procedure [ 2 , 3 , 4 , 5 ], with clinical and oncological outcomes comparable to those of video-assisted thoracoscopic surgery (VATS)/thoracotomy, both in early [ 6 , 7 , 8 , 9 ] and in advanced stages (II-IIIA NSCLC) with no differences in medium and long-term survival [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Learning Curve of Robotic Lobectomy for the Treatment of Lung Cancer: How Does It Impact on the Autonomic Nervous System of the Surgeon?

Mazzella

Mohamed

Maisonneuve

et al. 2023

JPM

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Objective: Our purpose is to define the learning curve for robot-assisted thoracoscopic surgery lobectomy by reporting the experience of a single surgeon. Material and methods: We progressively collected the data concerning the surgical performance of a single male thoracic surgeon, from the beginning of his robotic activity as first operator from January 2021 to June 2022. We evaluated several pre-, intra- and postoperative parameters concerning patients and intraoperative cardiovascular and respiratory outcomes of the surgeon, recorded during surgical interventions, in order to evaluate his cardiovascular stress. We used cumulative sum control charts (CUSUM) to analyze the learning curve. Results: A total of 72 lung lobectomies were performed by a single surgeon in this period. Analyzing the CUSUM of several parameters, the inflection point identifying the transition beyond the surgeon learning phase was reached at cases 28, 22, 27 and 33 when considering operating time, mean heart rate, max heart rate and mean respiratory rate, respectively. Conclusions: The learning curve for robotic lobectomy seems to be safe and feasible with a correct robotic training program. The analysis of a single surgeon from the beginning of his robotic activity demonstrates that confidence, competence, dexterity and security are achieved after about 20–30 procedures, without compromising efficiency and oncological radicality.

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“…The application of VATS in lung cancer surgery is well established, but VATS has some shortcomings: long learning curve, counterintuitive operation logic, lack of stereoscopic view, and poor instrument mobility, etc. The application of robot-assisted thoracoscopic surgery (RATS) can further solve these problems [4,5].…”

Section: Introductionmentioning

confidence: 99%

Effects of da Vinci robot versus thoracoscopic surgery on body trauma and lymphocyte subsets in lung cancer patients: a propensity score matching study

Hong

Sheng

Bai

et al. 2023

Preprint

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Objective To assess the impact of da Vinci robot versus thoracoscopic surgery on body trauma and lymphocyte subsets in lung cancer patients. Methods Retrospective analysis of 352 patients with lung cancer treated by minimally invasive surgery completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from October 2019 to October 2022. The patients were divided into a robotic-assisted thoracic surgery(RATS) group (n = 159) and a video-assisted thoracoscopic surgery group(VATS) (n = 193) according to the surgical procedure. Propensity score matching analysis (PSM) was performed in both groups, and perioperative indicators were recorded. Levels of inflammatory markers (C-reactive protein, CRP; interleukin-6, IL-6) and lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) were measured 1 day before surgery, 1, 3 and 5 days after surgery, respectively. To compare the effects of the two surgical procedures on the trauma and lymphocyte subsets of the patient's organism. Results 138 patients in each group after PSM. The operative time, intraoperative bleeding, postoperative drainage time, and drainage flow were all lower in the RATS group than in the VATS group, with statistically significant differences (P < 0.05). The levels of CRP and IL-6 increased in both groups after surgery compared with those before surgery, and the increase was less in the RATS group than in the VATS group. Postoperative T-lymphocyte levels were lower in both groups compared with preoperative levels, and T-lymphocyte levels were significantly lower in the VATS group compared with the RATS group (P < 0.05). Conclusion Compared with thoracoscopic radical lung cancer surgery, robotic radical lung cancer surgery is clinically superior because it is less invasive, induces less inflammatory response in the body, has faster recovery, and has less suppressive effects on lymphocyte subpopulations.

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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

Cited by 17 publications

References 41 publications

Opioid Free Anesthesia in Thoracic Surgery: A Systematic Review and Meta Analysis

Opioid Free Anesthesia in Thoracic Surgery: A Systematic Review and Meta Analysis

Learning Curve of Robotic Lobectomy for the Treatment of Lung Cancer: How Does It Impact on the Autonomic Nervous System of the Surgeon?

Effects of da Vinci robot versus thoracoscopic surgery on body trauma and lymphocyte subsets in lung cancer patients: a propensity score matching study

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