Short-term efficacy and cost analysis of Da Vinci robot-assisted thoracic surgery versus video-assisted thoracoscopic surgery for non-small cell lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HONG Ziqiang ^1,2 , GOU Wenxi ³ , LU Yingjie ¹ , BAI Xiangdou ^1,2 , CUI Baiqiang ^1,2 , JIN Dacheng ² ,  GOU Yunjiu ²

1. The First Clinical Department of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, P. R. China;
2. Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;
3. Southern Medical University, Guangzhou, 510515, P. R. China;

Corresponding?author：

GOU Yunjiu, Email: gouyunjiu@163.com

Keywords：

Robot-assisted thoracic surgery; video-assisted thoracoscopic surgery; non-small cell lung cancer; cost analysis

DOI：

10.7507/1007-4848.202209034

Video：

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Objective To evaluate the short-term outcomes and hospital costs of robot-assisted thoracic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for non-small cell lung cancer. Methods The clinical data of patients who underwent lobectomy or sublobar resection for non-small cell lung cancer completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial Hospital from June 2016 to June 2022 were retrospectively analyzed. According to the surgery approach, the patients were divided into a RATS group and a VATS group. The clinical data of the two groups were compared. Results A total of 516 patients were enrolled. There were 254 patients in the RATS group, including 103 males and 151 females, with a mean age of 60.0±4.2 years, and 262 patients in the VATS group, including 126 males and 136 females, with a mean age of 59.5±4.3 years. All patients in both groups successfully completed radical lung cancer surgery with no perioperative death. In terms of intraoperative bleeding (63.4±13.3 mL vs. 92.5±23.5 mL), postoperative drainage time (4.1±0.9 d vs. 4.7±1.2 d), postoperative hospital stay time (5.6±1.1 d vs. 6.7±1.4 d), number of lymph nodes dissected (17.9±2.1 vs. 13.9±1.4) and groups of lymph nodes dissected (5.4±0.8 groups vs. 4.4±1.0 groups), the RATS group had an advantage, and the difference was statistically significant (P<0.05). In terms of operative time and total postoperative chest drainage, the VATS group had an advantage, and the difference was statistically significant (P<0.05). There was no statistical difference between the two groups in terms of postoperative complications or intraoperative conversion to thoractomy (P>0.05). The total hospitalization, surgical and total consumables costs of the RATS group were higher than those in the VATS group (P<0.05). In terms of other costs and consumables costs (one-time costs of purely high-value consumables after deduction of robot-specific costs), the VATS group was higher than the RATS group (P<0.05). Conclusion RATS offers technical and short-term efficacy advantages, but comes with the disadvantage of high costs. Thoracic surgeons can make full use of the features of the robotic surgery system, exploiting its potential to continuously improve and optimize techniques and reduce the use of high-value consumables, thus achieving efficiency and cost reductions and allowing robotic surgery to reach more patients.

Citation： HONG Ziqiang, GOU Wenxi, LU Yingjie, BAI Xiangdou, CUI Baiqiang, JIN Dacheng, GOU Yunjiu. Short-term efficacy and cost analysis of Da Vinci robot-assisted thoracic surgery versus video-assisted thoracoscopic surgery for non-small cell lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(7): 974-979. doi: 10.7507/1007-4848.202209034 Copy

1.	Yuan MW, Wang HH, Duan RF, et al. Analysis on cancer incidence and mortality attributed to human papillomavirus infection in China, 2016. Zhonghua Liu Xing Bing Xue Za Zhi, 2022, 43(5): 702-708.
2.	Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol, 2009, 27(15): 2553-2562.
3.	Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stageⅠnon-small cell lung cancer: Comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265(2): 431-437.
4.	代鋒, 許世廣, 徐惟, 等. 達芬奇機器人與電視胸腔鏡輔助非小細胞肺癌根治術近期療效配對的病例對照研究. 中國肺癌雜志, 2018, 21(3): 206-211.
5.	陶紹霖, 康珀銘, 譚群友, 等. 經前側入路達芬奇機器人輔助肺段切除術的臨床分析. 中國胸心血管外科臨床雜志, 2020, 27(2): 178-182.
6.	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(2): 366-378.
7.	Paul S, Sedrakyan A, Chiu YL, et al. Outcomes after lobectomy using thoracoscopy vs. thoracotomy: A comparative effectiveness analysis utilizing the Nationwide Inpatient Sample Database. Eur J Cardiothorac Surg, 2013, 43(4): 813-817.
8.	王光宇, 初向陽, 李國, 等. 單操作孔電視胸腔鏡肺葉切除術的學習曲線研究. 中國醫藥, 2014, 9(5): 642-644.
9.	王述民. 達芬奇機器人在肺癌根治術中的應用現狀及展望. 中國腫瘤, 2014, 23(9): 736-742.
10.	Reddy RM, Gorrepati ML, Oh DS, et al. Robotic-assisted versus thoracoscopic lobectomy outcomes from high-volume thoracic surgeons. Ann Thorac Surg, 2018, 106(3): 902-908.
11.	O'Sullivan KE, Kreaden US, Hebert AE, et al. A systematic review and meta-analysis of robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy. Interact Cardiovasc Thorac Surg, 2019, 28(4): 526-534.
12.	Nelson DB, Mehran RJ, Mitchell KG, et al. Robotic-assisted lobectomy for non-small cell lung cancer: A comprehensive institutional experience. Ann Thorac Surg, 2019, 108(2): 370-376.
13.	Li C, Hu Y, Huang J, et al. Comparison of robotic-assisted lobectomy with video-assisted thoracic surgery for stage ⅡB-ⅢA non-small cell lung cancer. Transl Lung Cancer Res, 2019, 8(6): 820-828.
14.	Li JT, Liu PY, Huang J, et al. Perioperative outcomes of radical lobectomies using robotic-assisted thoracoscopic technique vs. video-assisted thoracoscopic technique: Retrospective study of 1, 075 consecutive p-stageⅠnon-small cell lung cancer cases. J Thorac Dis, 2019, 11(3): 882-891.
15.	Kneuertz PJ, Cheufou DH, D'Souza DM, et al. Propensity-score adjusted comparison of pathologic nodal upstaging by robotic, video-assisted thoracoscopic, and open lobectomy for non-small cell lung cancer. J Thorac Cardiovasc Surg, 2019, 158(5): 1457-1466.
16.	Shen C, Che G. Tubeless minimally invasive treatment: Taking a new step in enhanced recovery after surgery (ERAS). Thorac Cancer, 2019, 10(11): 2067-2070.
17.	金大成, 崔百強, 楊寧, 等. 國產圖邁?微創機器人輔助胸腔鏡手術三例. 中國胸心血管外科臨床雜志, 2022, 29(4): 524-528.

1. Yuan MW, Wang HH, Duan RF, et al. Analysis on cancer incidence and mortality attributed to human papillomavirus infection in China, 2016. Zhonghua Liu Xing Bing Xue Za Zhi, 2022, 43(5): 702-708.
2. Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol, 2009, 27(15): 2553-2562.
3. Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stageⅠnon-small cell lung cancer: Comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265(2): 431-437.
4. 代鋒, 許世廣, 徐惟, 等. 達芬奇機器人與電視胸腔鏡輔助非小細胞肺癌根治術近期療效配對的病例對照研究. 中國肺癌雜志, 2018, 21(3): 206-211.
5. 陶紹霖, 康珀銘, 譚群友, 等. 經前側入路達芬奇機器人輔助肺段切除術的臨床分析. 中國胸心血管外科臨床雜志, 2020, 27(2): 178-182.
6. 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(2): 366-378.
7. Paul S, Sedrakyan A, Chiu YL, et al. Outcomes after lobectomy using thoracoscopy vs. thoracotomy: A comparative effectiveness analysis utilizing the Nationwide Inpatient Sample Database. Eur J Cardiothorac Surg, 2013, 43(4): 813-817.
8. 王光宇, 初向陽, 李國, 等. 單操作孔電視胸腔鏡肺葉切除術的學習曲線研究. 中國醫藥, 2014, 9(5): 642-644.
9. 王述民. 達芬奇機器人在肺癌根治術中的應用現狀及展望. 中國腫瘤, 2014, 23(9): 736-742.
10. Reddy RM, Gorrepati ML, Oh DS, et al. Robotic-assisted versus thoracoscopic lobectomy outcomes from high-volume thoracic surgeons. Ann Thorac Surg, 2018, 106(3): 902-908.
11. O'Sullivan KE, Kreaden US, Hebert AE, et al. A systematic review and meta-analysis of robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy. Interact Cardiovasc Thorac Surg, 2019, 28(4): 526-534.
12. Nelson DB, Mehran RJ, Mitchell KG, et al. Robotic-assisted lobectomy for non-small cell lung cancer: A comprehensive institutional experience. Ann Thorac Surg, 2019, 108(2): 370-376.
13. Li C, Hu Y, Huang J, et al. Comparison of robotic-assisted lobectomy with video-assisted thoracic surgery for stage ⅡB-ⅢA non-small cell lung cancer. Transl Lung Cancer Res, 2019, 8(6): 820-828.
14. Li JT, Liu PY, Huang J, et al. Perioperative outcomes of radical lobectomies using robotic-assisted thoracoscopic technique vs. video-assisted thoracoscopic technique: Retrospective study of 1, 075 consecutive p-stageⅠnon-small cell lung cancer cases. J Thorac Dis, 2019, 11(3): 882-891.
15. Kneuertz PJ, Cheufou DH, D'Souza DM, et al. Propensity-score adjusted comparison of pathologic nodal upstaging by robotic, video-assisted thoracoscopic, and open lobectomy for non-small cell lung cancer. J Thorac Cardiovasc Surg, 2019, 158(5): 1457-1466.
16. Shen C, Che G. Tubeless minimally invasive treatment: Taking a new step in enhanced recovery after surgery (ERAS). Thorac Cancer, 2019, 10(11): 2067-2070.
17. 金大成, 崔百強, 楊寧, 等. 國產圖邁?微創機器人輔助胸腔鏡手術三例. 中國胸心血管外科臨床雜志, 2022, 29(4): 524-528.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Short-term efficacy and cost analysis of Da Vinci robot-assisted thoracic surgery versus video-assisted thoracoscopic surgery for non-small cell lung cancer

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