Comparison of Endoscopic Robotic versus Sternotomy Approach for the Resection of Left Atrial Tumors

摘要

OBJECTIVE: Primary cardiac tumors most commonly occur in the left atrium. The aim of this study was to compare outcomes among patients undergoing isolated left atrial tumor resection via sternotomy or robotic approach. METHODS: From 2003 to 2013, 69 patients underwent isolated left atrial tumor resection at 3 affiliated hospitals with either a sternotomy (n = 39) or robotic approach (n = 30). A retrospective review of prospectively collected data was performed, and outcomes were compared between the sternotomy and robotic groups. Univariate and multivariate analyses controlling for pertinent preoperative characteristics were performed. RESULTS: Patients' characteristics in the 2 groups were similar, with the exception of a history of chronic obstructive pulmonary disease (sternotomy, 12.8% vs robotic, 0%; P < 0.04) and elective surgical status (sternotomy, 64.1% vs robotic, 93.3%; P < 0.02). On univariate analysis, robotic-assisted surgery was associated with significantly shorter postoperative mechanical ventilation, intensive care unit (ICU) length of stay (LOS), hospital LOS, and a lower rate of perioperative blood transfusion. After controlling for patient comorbidity in a multiple logistic regression model, there remained a trend toward decreased blood transfusions (adjusted odds ratio, 0.33; CI, 0.09-1.20; P = 0.09), shorter ICU (16.3 fewer hours; P = 0.11), and hospital LOS (1.1 fewer days; P = 0.17) in the robotic group. There was one postoperative stroke in the sternotomy group and none in the robotic group (P = 0.21). CONCLUSIONS: Robotic-assisted left atrial tumor resection is feasible and may be associated with a lower incidence of perioperative blood transfusion as well as shorter ventilation time, and shorter ICU and hospital LOS.