基于上海市胸科医院13年临床实践，分析机器人辅助胸腔镜手术（RATS）治疗非小细胞肺癌（NSCLC）患者的围手术期和远期生存结局。

回顾性收集2009年5月至2022年5月于上海市胸科医院接受RATS肺部手术的连续NSCLC病例，分析患者基本信息、围手术期情况和长期生存结局。

共纳入1 798例患者，其中男性786例（43.7%）、女性1 012例（56.3%），平均年龄（59.4±9.1）岁。叶切、段切和楔切分别为1 557（86.6%）、112（6.2%）和129（7.2%）例。肿瘤平均直径（2.4±1.1）cm，以腺癌为最常见病理类型（90.3%）。手术平均时长（101.9±28.5）min，80.9%的患者出血量≤100 mL，中转开胸率3.8%，99.2%的患者达到阴性切缘。术中淋巴结清扫平均站数5.5±1.6和平均个数（11.2±5.2）枚。术后胸管平均引流量（710.5±268.3） mL、引流时间（3.2±1.8）天，术后平均住院时间（4.5±2.1）天。术后有332例（18.5%）患者出现并发症、其中23例（1.3%）为严重并发症。生存结局分析表明，RATS患者术后5年无复发生存率为82.5%、总生存率为88.8%。进一步多因素Cox回归分析显示年龄、病理类型、病理TNM分期和新辅助治疗史是影响患者无复发生存和总生存的独立预后因素。

RATS术中出血量少、中转开胸率低、术后并发症率低、长期生存结果较好。RATS在本中心经验中显示出较好的围手术期安全性和可接受的长期肿瘤学结局，是治疗NSCLC的可行手术方式。

To analyze the perioperative and long-term survival outcomes of robotic-assisted thoracoscopic surgery (RATS) in the treatment of patients with non-small cell lung cancer (NSCLC) based on the 13-year clinical practice at Shanghai Chest Hospital.

Consecutive patients with NSCLC who underwent RATS lung surgery at Shanghai Chest Hospital from May 2009 to May 2022 were retrospectively enrolled. Baseline demographic characteristics, perioperative parameters, and long-term survival outcomes were analyzed.

A total of 1 798 patients were included, consisting of 786 males (43.7%) and 1 012 females (56.3%), with a mean age of (59.4±9.1) years. There were 1 557 cases (86.6%) of lobectomy, 112 cases (6.2%) of segmentectomy, and 129 cases (7.2%) of wedge resection. The mean tumor diameter was (2.4±1.1) cm, and adenocarcinoma accounted for the predominant pathological type (90.3%). The mean operative duration was (101.9±28.5) minutes. 80.9% of patients had intraoperative blood loss ≤100 mL, the conversion rate to thoracotomy was 3.8%, and 99.2% of patients achieved negative surgical margins. The mean number of dissected lymph node stations was 5.5±1.6, with a mean of 11.2±5.2 lymph nodes retrieved. The mean postoperative chest tube drainage volume was (710.5±268.3) mL over a mean drainage duration of (3.2±1.8) days, and the mean postoperative hospital stay was (4.5±2.1) days. Postoperative complications occurred in 332 patients (18.5%), among whom 23 cases (1.3%) had severe complications. Survival analysis revealed that the 5-year recurrence-free survival (RFS) rate and overall survival (OS) rate were 82.5% and 88.8%, respectively. Further multivariable Cox regression analyses showed that age, histological subtype, pathological TNM stage, and neoadjuvant therapy were independent prognostic factors for RFS and OS.

RATS is associated with limited intraoperative blood loss, a low conversion rate to thoracotomy, a low postoperative complication rate, and favorable long-term survival outcomes. In our center’s clinical experience, RATS demonstrates favorable perioperative safety profiles and acceptable long-term oncological outcomes, making it a viable surgical approach for NSCLC.