Short-term efficacy of robot-assisted surgery versus video-assisted thoracoscopic surgery for anterior mediastinal mass

Abstract

Objective To compare the short-term clinical efficacy of robot-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) for anterior mediastinal mass and investigate the advantages of robot-assisted surgery. Methods This retrospective cohort study was conducted in 111 patients undergoing minimally invasive surgery for anterior mediastinal mass in Daping Hospital of Army Medical University between October, 2016 and September, 2017. Of the 111 patients, 56 underwent Da Vinci robotic surgery (RATS group) and 55 underwent VATS. The clinicopathological data were collected from the two groups for comparison of the tumor diameter, number of cases with tumor diameter ≥5 cm, operation time, intraoperative blood loss, conversion to open surgery rate, postoperative pleural drainage volume, days of pleural drainage, extended resection rate, postoperative hospital stay, complications and hospitalization costs. Results The operations were completed successfully in all the patients without perioperative mortality. Compared with those in VATS group, the patients with RATS had significantly larger tumor diameter (4.6±2.2 vs 3.3±1.6 cm, P=0.002), more cases with a tumor diameter ≥5 cm (22/56 vs 11/55, P=0.026), a less intraoperative blood loss volume (54.1±51.6 vs 89.9±91.0 mL, P=0.013), and a higher rate of extended resection (8/56 vs 1/54, P=0.040). The hospitalization costs in RATS group was much higher than that in VATS group (P < 0.001). No significant differences were found between the two groups in the operation time, conversion to open surgery rate, postoperative pleural drainage volume, days of pleural drainage, postoperative hospital stay or incidence of complications. Conclusion RATS is safe and feasible for treatment of anterior mediastinal mass, but its hospitalization costs are much higher. Compared with VATS, RATS is associated with less intraoperative blood loss and allows more convenient operations around large vessels and in deep and narrow space. RATS is more suitable for anterior mediastinal tumors with a larger diameter or with external invasion, which requires extended resection along with the large vessels.

Keywords

• anterior mediastinal mass
• robot-assisted surgery
• video-assisted thoracoscopic surgery
• minimally invasive thoracic surgery