Background: Recent trials, including JCOG0802/WJOG4607L and CALGB140503, have confirmed the oncological adequacy of segmentectomy for early-stage non-small-cell lung cancer (NSCLC). This shift emphasizes the preservation of pulmonary function and minimal invasiveness. Robot-assisted thoracic surgery (RATS) offers enhanced anatomical precision and potentially improves segmentectomy outcomes.Methods: We reviewed the current evidence comparing sublobar resection and lobectomy for early-stage NSCLC, focusing on RATS segmentectomy. Clinical trials, perioperative and long-term outcomes, technical innovations, and patient selection criteria were analyzed. Comparative data among RATS, video-assisted thoracoscopic surgery (VATS), and open approaches were synthesized, including the emerging roles of AI and 3D imaging.Results: Segmentectomy yields survival outcomes equivalent or superior to lobectomy for stage IA peripheral NSCLC ≤2 cm, with better pulmonary function despite higher locoregional recurrence. RATS enhances visualization, dexterity, and ergonomics, thereby enabling precise dissection and lymph node assessment. Compared to VATS and open surgery, RATS shows lower conversion rates, reduced pain, and comparable oncological control. Innovations, such as indocyanine green imaging, 3D modeling, and AI-guided navigation, support margin accuracy and personalized care.Conclusions: Segmentectomy has redefined the surgical standards for early-stage NSCLC. RATS maximizes the minimally invasive benefits by combining oncological safety and functional preservation. Its technical precision facilitates complex resections and integration with digital planning tools to advance personalized thoracic surgery. RATS represents the next evolution of minimally invasive thoracic surgery, redefining the balance between oncological safety and functional preservation in early-stage NSCLC.
背景：近期包括JCOG0802/WJOG4607L和CALGB140503在内的临床试验证实，肺段切除术治疗早期非小细胞肺癌（NSCLC）在肿瘤学上具有充分依据。这一转变强调肺功能保留与微创性。机器人辅助胸外科手术（RATS）提供更精准的解剖学操作，可能改善肺段切除术的疗效。 方法：我们系统回顾了当前关于早期NSCLC亚肺叶切除与肺叶切除比较的证据，重点关注RATS肺段切除术。通过分析临床试验、围手术期及长期结果、技术创新及患者选择标准，综合比较RATS、电视辅助胸腔镜手术（VATS）与开放手术的数据，涵盖人工智能与三维成像等新兴技术应用。 结果：对于≤2 cm的IA期周围型NSCLC，肺段切除术的生存结局与肺叶切除相当或更优，虽局部复发率较高但肺功能保留更佳。RATS通过增强可视化、操作灵活性和人机工程学优势，实现精准解剖和淋巴结评估。与VATS及开放手术相比，RATS中转开胸率更低、疼痛更轻，肿瘤控制效果相当。吲哚菁绿荧光成像、三维建模及AI导航等创新技术，有助于提升切缘精准度和实现个体化治疗。 结论：肺段切除术已重新定义早期NSCLC的手术标准。RATS通过融合肿瘤学安全性与功能保留，最大化微创手术优势。其技术精准性有助于复杂切除操作，并与数字化规划工具结合推动胸外科个体化治疗发展。RATS代表微创胸外科手术的进阶演化，在早期NSCLC治疗中重塑肿瘤学安全与功能保留的平衡关系。
肿瘤(癌症)患者之家