Comparison of robotic-assisted lobectomy with video-assisted thoracic surgery for stage IIB–IIIA non-small cell lung cancer

Abstract

Background: With the rapid development of surgical technics and instruments, more and more locally advanced non-small cell lung cancer (NSCLC) patients are being treated by minimally invasive surgery (MIS), including video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS). The aim of this retrospective study was to compare the perioperative and long-term outcomes of patients who underwent lobectomy by these two surgical approaches.Methods: We performed a retrospective review of the prospectively collected database of our hospital to identify patients with clinical stage IIB-IIIA NSCLC who underwent video-assisted thoracoscopic or robotic lobectomy. Perioperative outcomes, recurrence, and overall survival (OS) were compared.Results: From January 2014 to January 2017, there were at total of 121 patients, including 36 robotic lobectomy patients and 85 VATS lobectomy patients. One patient (2.8%) in the RATS group and 5 patients (5.9%) in the VATS group were converted to thoracotomy (P=0.79). No perioperative death was observed in both groups. The postoperative morbidity was similar between the two groups (13.9% for RATS vs. 15.3% for VATS; P=0.84). Robotic lobectomy was associated with a shorter length of postoperative hospital stay (4 vs. 5 d, P<0.01) and more counts of lymph nodes harvested (13 vs. 10, P<0.01). The median disease-free survival (DFS) for the RATS and VATS groups were 31.1 and 33.8 months, respectively. The corresponding 3-year DFS was 40.3% in the RATS group and 47.6% in the VATS group (P=0.74). The 3-year OS was 75.7% in RATS and 77.0% in the VATS group (P=0.75). Conclusions:For selected NSCLC patients with lymph node involvement, robotic lobectomy is safe and effective with a low complication rate and similar long-term outcome compared with VATS lobectomy. Moreover, the robotic approach resulted in shorter postoperative length of stay and greater lymph node assessment.

A uniportal right upper lobectomy by three-arm robotic-assisted thoracoscopic surgery using the da Vinci (Xi) Surgical System in the treatment of early-stage lung cancer

“…Despite respective innovations in these 2 directions, to our knowledge, the completion of RATS using a single incision has never been reported in the literature. With previous experience in both RATS and uniportal VATS (11)(12)(13)(14)(15), we report a Original Article A uniportal right upper lobectomy by three-arm robotic-assisted thoracoscopic surgery using the da Vinci (Xi) Surgical System in the treatment of early-stage lung cancer representative video case of right upper lobectomy in the treatment of a subsolid lung nodule (with final pathology of stage I adenocarcinoma) by uniportal RATS using the da Vinci Surgical System (Xi) shown as Video 1 as attached. We present the following article in accordance with the CARE reporting checklist (available at http://dx.doi.org/10.21037/ tlcr-21-207).…”

Robot-Assisted Thoracic Surgery Versus Video-Assisted Thoracic Surgery for Lung Lobectomy or Segmentectomy in Patients With Non-Small Cell Lung Cancer: A Meta-Analysis

“…One of the included studies reported that no local recurrence or distant recurrence appeared in the RATS group within the median 38-month follow-up time, while the local recurrence and distant recurrence rate in the VATS group was 2.5% and 3.75% respectively during a median follow-up time of 85 months [39]. Moreover, Li et al [34] reported that the recurrence rate was 52.8% in the RATS group and 54.1% in the VATS group during a median follow-up length of 33.9 months. The above all indicated that the long-term oncologic outcomes of RATS might be slightly better than VATS and con rmed that RATS is a feasible and safe technique for the management of NSCLC.…”

“…A total of 18 studies with 11247 patients, of whom 5114 patients were in the RATS group and 6133 in the VAST group, were involved in the analysis. Five included studies were published in Chinese [30,31,[35][36][37], and 13 were published in English [26][27][28][29][32][33][34][38][39][40][41][42][43] [40]. The basic characteristics of the included studies are listed in Table 1.…”

“…The quality assessment of the included studies according to the NOS is elucidated in Table 2. It showed that 9 of the 18 included studies had 7 stars [27,28,[31][32][33][35][36][37]41], 4 had 8 stars [26,30,34,42], and 5 had 9 stars [29,[38][39][40]43]. (1) Representativeness of the exposed cohort, (2) selection of the non-exposed cohort, (3) ascertainment of exposure, (4) demonstration that outcome of interest was not present at start of study, (5) assessment of outcome, (6) was follow-up long enough for outcomes to occur, (7) adequacy of follow-up of cohorts…”

Immune profiling after minimally invasive lobectomy

“…The results of retrospective studies comparing outcomes with RATS and VATS for the treatment of non-small-cell lung cancer (NSCLC) showed no difference between the 2 groups concerning the number of dissected lymph nodes, the length of hospital stay, anaesthesia and operative times, complication rates and morbidity [3]. In a limited number of retrospective studies, long-term survival rates were also found to be similar between the 2 groups [3,4]. These results suggest that RATS and VATS for lung cancer resection may have a similar immunosuppressive effect.…”