Comparison of the perioperative outcomes between robotic-assisted thoracic surgery and video-assisted thoracic surgery in non-small cell lung cancer patients with different body mass index ranges

Abstract

Background: Non-small cell lung cancer (NSCLC) is the most common malignancy and one of the most common causes of cancer-related death worldwide. Robotic-assisted thoracic surgery (RATS) has gradually become a prevalent surgical method for patients with NSCLC. Previous studies have found that body mass index (BMI) is associated with postoperative outcomes. This study aimed to investigate the effectiveness of RATS compared to video-assisted thoracic surgery (VATS) in the treatment of NSCLC with different BMI, in terms of perioperative outcomes. Methods:The baseline and perioperative data, including BMI, of 849 NSCLC patients who underwent minimally invasive anatomic lung resections from August 2020 to April 2021 were retrospectively collected and analyzed. Propensity score matching analysis was applied to minimize potential bias between the two groups (VATS and RATS), and the perioperative outcomes were compared. Subgroup analysis was subsequently performed.Results: Compared to VATS, RATS had more lymph nodes dissected {9 [inter-quartile range (IQR), 6-12] vs. 7 (IQR, 6-10), P<0.001}, a lower estimated bleeding volume [40 (IQR, 30-50) vs. 50 (IQR, 40-60) mL, P<0.001], and other better postoperative outcomes, but a higher cost of hospitalization [¥83,626 (IQR, 77,686) vs. ¥75,804 (IQR, 66,693), P<0.001]. Multivariable logistic regression analysis indicated that RATS (P=0.027) and increasing BMI (P=0.030) were associated with a statistically significant reduction in the risk of postoperative complications. Subgroup analysis indicated that the advantages of RATS may be more obvious in patients with a BMI of 24-28 kg/m 2 , in which the RATS group had more lymph nodes dissected [9 (IQR, 6-12) vs. 7 (IQR, 5-10), P<0.001] and a decreased risk of total postoperative complications [odds ratio (OR), 0.443; 95% confidence interval (CI), 0.212-0.924; P=0.030] compared to the VATS group.Conclusions: Both, RATS and VATS can be safely applied for patients with NSCLC. Perioperative outcome parameters indicate advantages for RATS, however at a higher cost of hospitalization. The advantages of RATS might be more obvious in patients with a BMI of 24-28 kg/m 2 .

Perioperative outcomes of robotic‐assisted versus video‐assisted thoracoscopic lobectomy: A propensity score matched analysis

“…Consequently, RATS surgery facilitates early extubation and discharge of patients, and this benefit is more pronounced after acquiring proficiency in RATS surgery (Period 2). This benefit stems from more meticulous anatomy and less pulmonary tissue damage of RATS surgery, which concurs with previous studies 16,19,26,40 …”

“…Previous literature showed heterogeneity in comparing operative time between VATS and RATS surgeries. Most clinical studies did not report an advantage for RATS surgery in operative time, and some even reported a disadvantage of longer operative time, 17,19,23,28,31,32 which was also confirmed by a large‐scale multicenter prospective randomized controlled clinical trial 33 . This may be related to the extra trocar placement time required for Da Vinci surgery, more surgical incisions made by surgeons during RATS surgery, and more experience required by surgeons for RATS surgery 21,34 .…”

“…Another meta‐analysis published in 2021 pointed out that there was no significant difference between RATS and VATS in terms of operative time, complications, hospital stay, pain, pulmonary function and postoperative survival rate, and so forth, but RATS was superior to VATS in terms of number of lymph nodes harvested number of lymph node stations harvested and blood loss 15 . Some studies have also suggested that patient selection bias and learning curve effect may be responsible for these heterogeneities 16–21 . Hence, more studies are needed to reveal the differences between them.…”

“…15 Some studies have also suggested that patient selection bias and learning curve effect may be responsible for these heterogeneities. [16][17][18][19][20][21] Hence, more studies are needed to reveal the differences between them. This study retrospectively reviewed single-center same-surgeon concurrent RATS versus VATS lobectomy for NSCLC to compare short-term perioperative outcomes, and performed subgroup analysis according to learning curve effect and specific operation type to further reveal the differences in outcomes between two surgeries.…”

Da Vinci robot versus thoracoscopic surgery for lymph node dissection in radical lung cancer: a propensity score matching study

“…VATS has been widely used in NSCLC surgery, but VATS has some shortcomings. The application of RATS further solves the problems of long learning curve of VATS, counter-intuitive operation logic, lack of stereoscopic vision and poor instrument mobility [4,5]. At the same time, RATS can effectively reduce surgeon fatigue, and for procedures that require more delicate and complex operations with longer operating times, RATS helps the operator to focus and ensures a smoother procedure [6].…”