Quality of life after anterior mediastinal mass resection: a prospective study comparing open with robotic-assisted thoracoscopic resection
Quality of life after anterior mediastinal mass resection: a prospective study comparing open with robotic-assisted thoracoscopic resection
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DOI：
10.1016/j.ejcts.2010.08.009
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发表时间：
2011-04-01
影响因子：
3.4
通讯作者：
Van Schil, Paul
中科院分区：
文献类型：
--
作者：
Balduyck, Bram;Hendriks, Jeroen M.;Van Schil, Paul
目的：通过欧洲癌症研究与治疗组织（EORTC）生活质量问卷- c30和肺癌特异性模块LC-13，前瞻性评估机器人辅助胸腔镜或前纵隔开放性肿瘤切除术后的生活质量（QoL）演变。方法：对2004年1月至2008年12月所有纵隔肿瘤手术患者的生活质量进行前瞻性记录。共有14例患者使用达芬奇机器人系统（Intuitive Surgical, Inc., Mountain View， CA， USA）进行胸腔镜切除，22例患者通过胸骨切开术进行切开切除。术前、术后1、3、6、12个月分别进行问卷调查，有效率分别为100%、86.1%、94.4%；分别为75.0%和86.1%。结果：两种方法具有相当的术前患者特征和生活质量亚量表。胸骨切开开放性切除术的特点是术后1个月一般功能显著下降（身体功能p = 0.001，角色功能p = 0.001，社会功能p = 0.044）。患者在术后3个月内胸痛加重（p = 0.017）。在达芬奇机器人切除术后1个月，生活质量评分接近术前基线值，除了术后前3个月胸部和肩部疼痛增加（p分别= 0.028和0.029）。结论：已发表的许多技术具有不同程度的侵袭性，引起了关于哪一种是前纵隔肿瘤的最佳手术入路的争议。据报道，胸骨切开术后身体功能下降的高负担在达芬奇机器人辅助胸腔镜切除后未见。初步经验和术后生活质量数据都很好，因此，达芬奇机器人将成为我们未来在成像技术上治疗小于4厘米的可复位纵隔肿瘤的首选技术。(C) 2010欧洲心胸外科协会。Elsevier B.V.版权所有。
Objective: To prospectively evaluate quality of life (QoL) evolution after robotic-assisted thoracoscopic or open anterior mediastinal tumour resection with the European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire-C30 and the lung cancer-specific module, LC-13. Methods: From January 2004 to December 2008, QoL was prospectively recorded in all patients undergoing surgery for mediastinal tumours. A total of 14 patients underwent thoracoscopic resection using the da Vinci robotic system (Intuitive Surgical, Inc., Mountain View, CA, USA), and 22 patients open resection through sternotomy. Questionnaires were administered before surgery and 1, 3, 6 and 12 months, postoperatively, with response rates of 100%, 86.1%, 94.4%; 75.0% and 86.1%, respectively. Results: Both approaches had comparable preoperative patients' characteristics and QoL subscales. Open resection by sternotomy was characterised by a significant decrease in general functioning 1 month after surgery (physical functioning p = 0.001, role functioning p = 0.001, and social functioning p = 0.044). Patients also complained of increased thoracic pain in the first 3 months after surgery ( p = 0.017). After a da Vinci robotic resection QoL scores approximated baseline preoperative values 1 month after surgery, with the exception of increase in thoracic and shoulder pain the first 3 months after surgery (p = 0.028 and 0.029, respectively). Conclusions: Numerous techniques have been published with different degrees of invasiveness, generating the existing controversy as to which is the best surgical approach for anterior mediastinal tumours. The high burden of decreased physical functioning reported after sternotomy is not seen after a da Vinci robotic-assisted thoracoscopic resection. The initial experience and postoperative QoL data are excellent and, therefore, the da Vinci robot will stay our future technique of choice for the treatment of resettable mediastinal tumours smaller than 4 cm on imaging techniques. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.