机器人辅助胸腔外科手术（Robot-assisted thoracic surgery，RATS）近几年来逐渐开始用于早期非小细胞肺癌（Non-small cell lung cancer，NSCLC）患者的手术治疗，但其与已经发展较为成熟的视频辅助胸腔外科手术（Video-assisted thoracic surgery，VATS）相比，优劣对比仍存争议。近期研究发现，在解剖性肺叶切除术中，相较于 VATS，虽然 RATS 的手术时间延长、成本明显增加，但由于 RATS 具有更好的术中稳定性和安全性，患者依旧可以从中获益，包括术中出血少、中转开胸率低和淋巴结清扫多，患者 30d 死亡率、住院时间等也明显减少。在袖式肺叶切除术中，RATS 在支气管吻合、气道重建和术后并发症等方面也展现了独特的优势。本文就近几年 RATS 与VATS 在不同手术方式下治疗 NSCLC 中的研究进展进行综述。

Robot-assisted thoracic surgery (RATS) has been gradually used in patients with early non-small cell lung cancer (NSCLC) in recent years. However, the pros and cons of RATS and video-assisted thoracic surgery (VATS) is still disputed. Recent studies have found that patients can benefit from the better intraoperative stability and safety of RATS in anatomical lobectomy compared with VATS, although the operation time of RATS is longer and the cost is significantly increased. Benefits include less intraoperative bleeding, lower conversion rate and more lymph node dissection, and significantly reduced 30d mortality rate and hospital stay. In sleeve lobectomy, RATS also shows its unique advantages on broncho anastomosis, airway reconstruction and reducing of postoperative complications. This article reviews the recent literatures on research progress of RATS and VATS on treating NSCLC with different approaches.

收稿日期：2021-02-18  录用日期：2021-07-23

Received Date: 2021-02-18  Accepted Date: 2021-07-23

基金项目：国家重点研发计划（2017YFC0113500）；浙江省重大科技专项计划项目（2020C03058）；浙江省肺部肿瘤诊治技术研究中心（JBZX-202007）；浙江省医药卫生科技计划（2016KYB258）

Foundation Item: National Key Research and Development Program of China(2017YFC0113500); Major Science and Technology Projects of Zhejiang Province(2020C03058); Lung Tumor Diagnosis and Treatment Technology Research Center of Zhejiang Province(JBZX-202007); Medical Health Science and Technology Projects of Zhejiang Provincial Health Commission(2016KYB258)

通讯作者：胡坚，Email：dr_hujian@zju.edu.cn

Corresponding Author: HU Jian, Email: dr_hujian@zju.edu.cn

引用格式：唐慕虎，励新健，汪路明，等 . 不同手术方式下应用 RATS 和 VATS 治疗非小细胞肺癌的研究进展 [J]. 机器人外科学杂 志（中英文），2022，3（1）：27-32.

Citation: TANG M H, LI X J, WANG L M, et al. Research progress of RATS and VATS on treating non-small cell lung cancer with different approaches [J]. Chinese Journal of Robotic Surgery, 2022, 3 (1): 27-32.

[1] Global Burden of Disease Cancer Collaboration. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disabilityadjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the global burden of disease study[J]. JAMA Oncol, 2019, 5(12): 1749-1768.

[2] Gharagozloo F, Margolis M, Tempesta B, et al. Robotassisted lobectomy for early-stage lung cancer: report of 100 consecutive cases[J]. Ann Thorac Surg, 2009, 88(2): 380-384.

[3] 杜祥民 , 张永寿 . 达芬奇手术机器人系统介绍及应 用进展 [J]. 中国医学装备 , 2011, 8(5): 60-63.

[4] 王述民 . 达芬奇机器人在肺癌根治术中的应用现状 及展望 [J]. 中国肿瘤 , 2014, 23(9): 736-742.

[5] ZHANG Y, CHEN C, HU J, et al. Early outcomes of robotic versus thoracoscopic segmentectomy for earlystage lung cancer: A multi-institutional propensity score-matched analysis[J]. J Thorac Cardiovasc Surg, 2020, 160(5): 1363-1372.

[6] 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]. J Thorac Dis, 2018, 10(2): 790-798.

[7] Cerfolio R J, Bess K M, Wei B, et al. Incidence, results, and our current intraoperative technique to control major vascular injuries during minimally invasive robotic thoracic surgery[J]. Ann Thorac Surg, 2016, 102(2): 394-399.

[8] LI S, ZHOU K, LAI Y, et al. Estimated intraoperative blood loss correlates with postoperative cardiopulmonary complications and length of stay in patients undergoing video-assisted thoracoscopic lung cancer lobectomy: a retrospective cohort study[J]. BMC Surg, 2018, 18(1): 29.

[9] Nelson D B, Mehran R J, Mitchell K G, et al. Roboticassisted lobectomy for non-small cell lung cancer: a comprehensive institutional experience[J]. Ann Thorac Surg, 2019, 108(2): 370-376.

[10] Oh D S, Reddy R M, Gorrepati M L, et al. Roboticassisted, video-assisted thoracoscopic and open lobectomy: propensity-matched analysis of recent premier data[J]. Ann Thorac Surg, 2017, 104(5): 1733-1740.

[11] LIU XC, XU SG, LIU B, et al. Survival analysis of stage i non-small cell lung cancer patients treated with da vinci robot-assisted thoracic surgery[J]. Zhongguo Fei Ai Za Zhi, 2018, 21(11): 849-856.

[12] Denlinger C E, Fernandez F, Meyers B F, et al. Lymph node evaluation in video-assisted thoracoscopic lobectomy versus lobectomy by thoracotomy[J]. Ann Thorac Surg, 2010, 89(6): 1730-1735.

[13] Zirafa C, Aprile V, Ricciardi S, et al. Nodal upstaging evaluation in NSCLC patients treated by robotic lobectomy[J]. Surg Endosc, 2019, 33(1): 153-158.

[14] Reddy R M, Gorrepati M L, Oh D S, et al. RoboticAssisted Versus Thoracoscopic Lobectomy Outcomes From High-Volume Thoracic Surgeons[J]. Ann Thorac Surg, 2018, 106(3): 902-908.

[15] LIANG H, LIANG W, ZHAO L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: a meta-analysis[J]. Ann Surg, 2018, 268(2): 254-259.

[16] Emmert A, Straube C, Buentzel J, et al. Robotic versus thoracoscopic lung resection: a systematic review and meta-analysis[J]. Medicine (Baltimore), 2017, 96(35): e7633.

[17] Paul S, Jalbert J, Isaacs A J, et al. Comparative effectiveness of robotic-assisted vs thoracoscopic lobectomy[J]. Chest, 2014, 146(6): 1505-1512.

[18] Louie B E, Wilson J L, 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[J]. Ann Thorac Surg, 2016. DOI: 10.1016/ j.athoracsur.2016.03.032

[19] Deen S A, Wilson J L, Wilshire C L, et al. Defining the cost of care for lobectomy and segmentectomy: a comparison of open, video-assisted thoracoscopic, and robotic approaches[J]. Ann Thorac Surg, 2014, 97(3): 1000-1007.

[20] Kajiwara N, Patrick Barron J, Kato Y, et al. Cost-benefit performance of robotic surgery compared with videoassisted thoracoscopic surgery under the Japanese National Health Insurance System[J]. Ann Thorac Cardiovasc Surg, 2015, 21(2): 95-101.

[21] Chen S, Geraci T C, Cerfolio R J. Techniques for lung surgery: a review of robotic lobectomy[J]. Expert Rev Respir Med, 2018, 12(4): 315-322.

[22] Cao C, Manganas C, Ang S C, et al. A systematic review and meta-analysis on pulmonary resections by robotic video-assisted thoracic surgery[J]. Ann Cardiothorac Surg, 2012, 1(1): 3-10.

[23] Kent M, Wang T, Whyte R, et al. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database[J]. Ann Thorac Surg, 2014, 97(1): 236-242.

[24] YANG H X. Long-term survival of early-stage nonsmall cell lung cancer patients who underwent robotic procedure: a propensity score-matched study[J]. Chin J Cancer, 2016 , 35(1): 66.

[25] LIN M W, KUO S W, YANG S M, et al. Roboticassisted thoracoscopic sleeve lobectomy for locally advanced lung cancer[J]. J Thorac Dis, 2016, 8(7): 1747-1752.

[26] Schmid T, Augustin F, Kainz G, et al. Hybrid videoassisted thoracic surgery-robotic minimally invasive right upper lobe sleeve lobectomy[J]. Ann Thorac Surg, 2011, 91(6): 1961-1965.

[27] Egberts J H, Möller T, Becker T. Robotic-Assisted Sleeve Lobectomy Using the Four-Arm Technique in the DaVinci Si® and Xi® Systems[J]. Thorac Cardiovasc Surg, 2019, 67(7): 603-605.

[28] QIU T, ZHAO Y, XUAN Y, et al. Robotic sleeve lobectomy for centrally located non-small cell lung cancer: A propensity score-weighted comparison with thoracoscopic and open surgery[J]. J Thorac Cardiovasc Surg, 2020, 160(3): 838-846.

[29] Pignon J P, Tribodet H, Scagliotti G V, et al. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group[J]. J Clin Oncol, 2008, 26(21): 3552-3559.

[30] NSCLC Meta - analysis Collaborative Group. Preoperative chemotherapy for non-small-cell lung cancer: a systematic review and meta-analysis of individual participant data[J]. Lancet, 2014, 383(9928): 1561-1571.

[31] BAO F, ZHANG C, YANG Y, et al. Comparison of robotic and video-assisted thoracic surgery for lung cancer: a propensity-matched analysis[J]. J Thorac Dis, 2016, 8(7): 1798-1803.