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Wu H, Li H. Reply to Huang et al. Eur J Cardiothorac Surg 2022; 62:6535924. [PMID: 35211722 DOI: 10.1093/ejcts/ezac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/14/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Han Wu
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Huang Y, Li H, Zhang J. The inclusion criteria was flawed in the systematic review and meta-analysis by Wu et al. Eur J Cardiothorac Surg 2022; 62:6534099. [PMID: 35190813 DOI: 10.1093/ejcts/ezac107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/01/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Yanruo Huang
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Hui Li
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jianyong Zhang
- Department of General Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Wu H, Jin R, Yang S, Park BJ, Li H. Long-term and short-term outcomes of robot- versus video-assisted anatomic lung resection in lung cancer: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2021; 59:732-740. [PMID: 33367615 DOI: 10.1093/ejcts/ezaa426] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/10/2020] [Accepted: 10/22/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Minimally invasive thoracic surgery has evolved with the introduction of robotic platforms. This study aimed to compare the long-term and short-term outcomes of the robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for anatomic lung resection. METHODS We searched published studies that investigated RATS and VATS in anatomic lung resection. Long-term outcomes (disease-free survival and overall survival) and short-term outcomes (30-day mortality, postoperative complications, conversion rate to open surgery and lymph node upstaging) were extracted. The features were compared and tested as hazard ratios (HRs) and odds ratios (ORs) at a 95% confidence interval (CI). RESULTS Twenty-five studies with 50 404 patients (7135 for RATS and 43 269 for VATS) were included. The RATS group had a longer disease-free survival than the VATS group (HR: 0.76; 95% CI: 0.59-0.97; P = 0.03), and the overall survival showed a similar trend but was not statistically significant (HR: 0.77; 95% CI: 0.57-1.05; P = 0.10). The RATS group showed a significantly lower 30-day mortality (OR: 0.55; 95% CI: 0.38-0.81; P = 0.002). No significant difference was found in postoperative complications (OR: 1.01; 95% CI: 0.87-1.16; P = 0.94), the conversion rate to open surgery (OR: 0.92; 95% CI: 0.56-1.52; P = 0.75) and lymph node upstaging (OR: 0.89; 95% CI: 0.52-1.54; P = 0.68). CONCLUSIONS RATS has comparable short-term outcomes and potential long-term survival benefits for anatomic lung resection compared with VATS.
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Affiliation(s)
- Han Wu
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Runsen Jin
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Su Yang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Hu X, Wang M. Efficacy and Safety of Robot-assisted Thoracic Surgery (RATS) Compare with Video-assisted Thoracoscopic Surgery (VATS) for Lung Lobectomy in Patients with Non-small Cell Lung Cancer. Comb Chem High Throughput Screen 2020; 22:169-178. [PMID: 30973106 DOI: 10.2174/1386207322666190411113040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/15/2018] [Accepted: 11/02/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND In the past decade, many researchers focused on Robotic- Assisted Thoracoscopic Surgery (RATS), which has been introduced as an alternative minimally invasive approach, versus Video- Assisted Thoracoscopic Surgery (VATS) for lung lobectomy in patients with non-small cell lung cancer. However, the advantage of RVATS compared to VATS is still under investigation. The results are unclear. AIM The aim of this study is to compare the efficacy and safety of Robot-assisted Thoracic Surgery (RATS) lobectomy versus Video-assisted Thoracic Surgery (VATS) for lobectomy in patients with Non- Small Cell Lung Cancer (NSCLC). METHODS A systematic electronic search of online electronic databases: Pubmed, Embase, Cochrane library updated in June 2017. The meta-analysis was performed including the studies are designed as randomized or non- randomized controlled. RESULTS Twenty retrospective cohort studies met our inclusion criteria. The pooled analysis of mortality showed that RATS lobectomy significantly reduced the mortality rate when compared with VATS lobectomy (RR =0.53, 95% CI 0.37 - 0.76; P = 0.0005). With the pooled result of duration of surgery indicated that RATS has a tendency towards longer surgery time (SMD= 0.52, 95% CI 0.23- 0.81; P < 0.0004=). However, the meta-analysis on the median length of hospital stay (MD =0.00, 95% CI -0.03 - 0.03; P = 0.91), number of dissected lymph nodes station (SMD =0.39, 95% CI -0.60 - 1.38; P = 0.44), the number of removed lymph nodes (SMD =0.98, 95% CI -0.61 - 2.56; P = 0.23), mean duration of drainage (SMD =0.29, 95% CI -0.15 - 0.73; P = 0.20), prolonged air leak (RR =1.01, 95% CI 0.84 - 1.21; P = 0.93), arrhythmia (RR =1.06, 95% CI 0.88 - 1.26; P = 0.54) (P= 0.54), pneumonia (RR =0.89, 95% CI 0.69 - 1.13; P = 0.33), the incidence of conversion (RR =0.82, 95% CI 0.54 - 1.26; P = 0.37) and morbidity (RR =1.05, 95% CI 0.90 - 1.23; P = 0.055) all showed no significant differences between RATS and VATS lobectomy. CONCLUSIONS RATS result in better mortality as compared with VATS. However, robotics seems to have longer operative time and higher hospital costs, without superior advantages in morbidity rates and oncologic efficiency. Since the advantages of RATS has been performed in some area, the continuation of a comparative investigation with VATS may be necessary. And some efforts need to be taken into consideration to reduce the operative time and cost.
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Affiliation(s)
- Xun Hu
- Department of Thoracic Surgery, The Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang, China
| | - Ming Wang
- Department of Thoracic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, Zhejiang, China
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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: A Meta-analysis. Medicine (Baltimore) 2019; 98:e17089. [PMID: 31574808 PMCID: PMC6775418 DOI: 10.1097/md.0000000000017089] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
To determine if there are advantages to transitioning to Da Vinci robotics by a surgeon compared to the video-assisted thoracic surgical lobectomy.A systematic electronic search of online electronic databases: PubMed, Embase, and Cochrane library updated on December 2017. Publications on comparison Da Vinci-robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for non-small cell lung cancer were collected. Meta-analysis RevMan 5.3 software (The Cochrane collaboration, Oxford, UK) was used to analyze the combined pooled HRs using fixed or random-effects models according to the heterogeneity.Fourteen retrospective cohort studies were included. No statistical difference was found between the 2 groups with respect to conversion to open, dissected lymph nodes number, hospitalization time after surgery, duration of surgery, drainage volume after surgery, prolonged air leak, and morbidity (P > .05).Da Vinci-RATS lobectomy is a feasible and safe technique and can achieve an equivalent surgical efficacy when compared with VATS. There does not seem to be a significant advantage for an established VATS lobectomy surgeon to transition to robotics based on clinical outcomes.
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Yu Z, Xie Q, Guo L, Chen X, Ni C, Luo W, Li W, Ma L. Perioperative outcomes of robotic surgery for the treatment of lung cancer compared to a conventional video-assisted thoracoscopic surgery (VATS) technique. Oncotarget 2017; 8:91076-91084. [PMID: 29207626 PMCID: PMC5710907 DOI: 10.18632/oncotarget.19533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 07/11/2017] [Indexed: 11/25/2022] Open
Abstract
Aim To conduct a meta-analysis to determine the relative merits between robotic video-assisted thoracoscopic surgery (R-VATS) and conventional video-assisted thoracoscopic surgery (VATS) for lung cancer. Results Fifteen studies matched the selection criterion, which reported 8827 subjects, of whom 1704 underwent R-VATS and 7123 underwent VATS. Compared the perioperative outcomes with VATS, reports of R-VATS indicated unfavorable outcomes considering the operative time (SMD = 0.48, 95% CI 0.15 to 0.81). Meanwhile, the number of dissected lymph nodes (SMD = 0.12, 95% CI -0.27 to 0.51) and hospital stay following surgery (SMD = -0.1; 95% CI -0.27 to 0.07), conversion (RR = 0.68; 95% CI 0.42 to 1.11), morbidity (RR = 0.99, 95% CI 0.92 to 1.07) and mortality (RR = 0.33, 95% CI 0.1 to 1.09) were similar for both procedures. Materials and Methods A literature search was performed to identify comparative studies reporting perioperative outcomes for R-VATS and VATS for lung cancer. Pooled risk ratio (RR) and standardized mean differences (SMDs) with 95% confidence intervals (95% CIs) were calculated using either the fixed effects model or the random effects model. Conclusions There is no difference in terms of perioperative outcomes between R-VATS and VATS except for the operative time which is significantly high for R-VATS. Further studies are required to confirm these results.
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Affiliation(s)
- Zipu Yu
- Department of Thoracic Surgery, 2nd Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Qiong Xie
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Lei Guo
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Xin Chen
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Chenyao Ni
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Wenzong Luo
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Weidong Li
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Liang Ma
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
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Wei S, Chen M, Chen N, Liu L. Feasibility and safety of robot-assisted thoracic surgery for lung lobectomy in patients with non-small cell lung cancer: a systematic review and meta-analysis. World J Surg Oncol 2017; 15:98. [PMID: 28482928 PMCID: PMC5422947 DOI: 10.1186/s12957-017-1168-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 05/02/2017] [Indexed: 02/05/2023] Open
Abstract
Background The aim of this study is to evaluate the feasibility and safety of robot-assisted thoracic surgery (RATS) lobectomy versus video-assisted thoracic surgery (VATS) for lobectomy in patients with non-small cell lung cancer (NSCLC). Methods An electronic search of six electronic databases was performed to identify relevant comparative studies. Meta-analysis was performed by pooling the results of reported incidence of overall morbidity, mortality, prolonged air leak, arrhythmia, and pneumonia between RATS and VATS lobectomy. Subgroup analysis was also conducted based on matched and unmatched cohort studies, if possible. Relative risks (RR) with their 95% confidence intervals (CI) were calculated by means of Revman version 5.3. Results Twelve retrospective cohort studies were included, with a total of 60,959 patients. RATS lobectomy significantly reduced the mortality rate when compared with VATS lobectomy (RR = 0.54, 95% CI 0.38–0.77; P = 0.0006), but this was not consistent with the pooled result of six matched studies (RR = 0.12, 95% CI 0.01–1.07; P = 0.06). There was no significant difference in morbidity between the two approaches (RR = 0.97, 95% CI 0.85–1.12; P = 0.70). Conclusions RATS lobectomy is a feasible and safe technique and can achieve an equivalent short-term surgical efficacy when compared with VATS, but its cost effectiveness also should be taken into consideration.
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Affiliation(s)
- Shiyou Wei
- Department of Thoracic surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, China
| | - Minghao Chen
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, 510010, China
| | - Nan Chen
- Department of Thoracic surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, China
| | - Lunxu Liu
- Department of Thoracic surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, China. .,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, China.
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Yang B, Zhao F, Zong Z, Yuan J, Song X, Ren M, Meng Q, Dai G, Kong F, Xie S, Cheng S, Gao T. Preferences for treatment of lobectomy in Chinese lung cancer patients: video-assisted thoracoscopic surgery or open thoracotomy? Patient Prefer Adherence 2014; 8:1393-7. [PMID: 25336927 PMCID: PMC4199753 DOI: 10.2147/ppa.s68426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study was designed to investigate the preferences for treatment of lobectomy in Chinese lung cancer patients and differences in the psychological and social factors that influence treatment decision-making. METHODS One hundred and forty patients with stage I lung cancer were recruited from Hebei Cangzhou Central Hospital. Before surgery, the patients completed a questionnaire that surveyed their preferences for treatment and the relevant influencing factors. Differences in psychological and social characteristics were compared between lung cancer patients who chose video-assisted thoracoscopic surgery (VATS) and those who opted for open thoracotomy. RESULTS Among the 135 valid questionnaires, 79 patients preferred VATS and 56 patients chose open thoracotomy. Potential side effects, doctors' recommendation, the prognosticated chance for cure, cosmesis, and financial burden influenced the patients' decisions. CONCLUSION The minimally invasive advantages of VATS, including lesser trauma to the chest wall, earlier remission of postoperative pain, faster recovery, less bleeding, and improved cardiopulmonary function made VATS more attractive to patients needing lobectomy for lung cancer. However, the choice of VATS over open thoracotomy is still influenced by the degree of prognosticated cure and the feasibility of surgery.
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Affiliation(s)
- Bo Yang
- Hebei Cangzhou Central Hospital, Department of Thoracic Surgery, Hebei, People’s Republic of China
- Correspondence: Bo Yang, Hebei Cangzhou Central Hospital, Department of Thoracic Surgery, Hebei 061000, People’s Republic of China, Tel +86 031 7207 5624, Fax +86 031 7207 5624, Email
| | - Fang Zhao
- Hebei Cangzhou Central Hospital, Department of Thoracic Surgery, Hebei, People’s Republic of China
| | - Zhenfeng Zong
- Hebei Cangzhou Central Hospital, Department of Thoracic Surgery, Hebei, People’s Republic of China
| | - Jun Yuan
- Hebei Cangzhou Central Hospital, Department of Thoracic Surgery, Hebei, People’s Republic of China
| | - Xiang Song
- Hebei Cangzhou Central Hospital, Department of Thoracic Surgery, Hebei, People’s Republic of China
| | - Mingming Ren
- Hebei Cangzhou Central Hospital, Department of Thoracic Surgery, Hebei, People’s Republic of China
| | - Qingjun Meng
- Hebei Cangzhou Central Hospital, Department of Thoracic Surgery, Hebei, People’s Republic of China
| | - Guoguang Dai
- Hebei Cangzhou Central Hospital, Department of Thoracic Surgery, Hebei, People’s Republic of China
| | - Fanyi Kong
- Hebei Cangzhou Central Hospital, Department of Thoracic Surgery, Hebei, People’s Republic of China
| | - Shumin Xie
- Xiangya Medical School of Central-South University, Changsha, People’s Republic of China
| | - Siying Cheng
- Xiangya Medical School of Central-South University, Changsha, People’s Republic of China
| | - Tianwen Gao
- Xiangya Medical School of Central-South University, Changsha, People’s Republic of China
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