Perioperative and Oncological Outcomes of Robotic-Assisted, Video-Assisted Thoracoscopic and Open Lobectomy for Patients with N1-Metastatic Non-Small Cell Lung Cancer: A Propensity Score-Matched Study

Abstract

(1) Background: Despite the fact that robotic-assisted thoracoscopic lobectomy (RATL) has been prevalently applied for early stage non-small cell lung cancer (NSCLC), its superiorities are still to be fully revealed for patients with metastatic N1 lymph nodes (LNs). We aim to evaluate the advantages of RATL for N1 NSCLC. (2) Methods: This retrospective study identified consecutive pathological N1 NSCLC patients undergoing RATL, video-assisted thoracoscopic lobectomy (VATL), or open lobectomy (OL) in Shanghai Chest Hospital between 2014 and 2020. Further, perioperative and oncological outcomes were investigated. (3) Results: A total of 855 cases (70 RATL, 435 VATL, and 350 OL) were included. Propensity score matching resulted in 70, 140, and 140 cases in the RATL, VATL, and OL groups, respectively. RATL led to (1) the shortest surgical time (p = 0.005) and lowest intraoperative blood loss (p < 0.001); (2) the shortest ICU (p < 0.001) and postsurgical hospital (p < 0.001) stays as well as chest tube duration (p < 0.001); and (3) the lowest morbidities of postsurgical complications (p = 0.016). Moreover, RATL dissected more N1 (p = 0.027), more N1 + N2 (p = 0.027) LNs, and led to a higher upstaging incidence rate (p < 0.050) than VATL. Finally, RATL achieved a comparable 5-year disease-free and overall survival in relation to VATL and OL. (4) Conclusions: RATL led to the most optimal perioperative outcomes among the three surgical approaches and showed superiority in assessing N1 and total LNs over VATL, though it did achieve comparable oncological outcomes in relation to VATL and OL for N1 NSCLC patients.

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

“…Some centers included surgical preparation time while others did not, which may also be a reason why some centers reported longer operative time for RATS surgery. Conversely, some high‐volume surgical centers reported an advantage for RATS surgery over VATS surgery in terms of operative time due to its flexible operation 16,18,20,21,35,36 . Li et al suggested in their study that the highly flexible surgical robot could save more time for surgeons during lymph node dissection especially among obese patients 20 .…”

“…In this study, whether it was matched patients or two subgroup analyses, there were no statistical differences between the RATS and VATS groups regarding intraoperative blood loss. In numerous studies, compared with VATS surgeries, RATS surgeries have advantages regarding blood loss amount, 19–21,33,34 but studies which have shown no difference between RATS and VATS surgeries regarding blood loss amount have previously been reported 16,18,36,37 . During minimally invasive lobectomy, intraoperative bleeding often occurs during freeing vessels or clearing lymph nodes.…”

“…Conversely, some high-volume surgical centers reported an advantage for RATS surgery over VATS surgery in terms of operative time due to its flexible operation. 16,18,20,21,35,36 Li et al suggested in their study that the highly flexible surgical robot could save more time for surgeons during lymph node dissection especially among obese patients. 20 After subgroup analysis related to surgical stage it was found that at initial stage (Period 1) of performing RATS surgeries, the operation duration was significantly longer than that for the VATS group, while after mastering skills (Period 2), the operation duration were similar between two groups, indicating that operation proficiency also has significant impact on operation duration.…”

“…In numerous studies, compared with VATS surgeries, RATS surgeries have advantages regarding blood loss amount, [19][20][21]33,34 but studies which have shown no difference between RATS and VATS surgeries regarding blood loss amount have previously been reported. 16,18,36,37 During minimally invasive lobectomy, intraoperative bleeding often occurs during freeing vessels or clearing lymph nodes. A robot-assisted system due to its larger magnification ratio as well as more flexible operation mode can help doctors perform fine operations during the above steps, reducing bleeding.…”

Early outcomes of minimally invasive surgery versus thoracotomy for non-small cell lung cancer patients with neoadjuvant immunochemotherapy: a multi-center propensity score- matched study

“…Consequently, conventional thoracotomy remains the predominant surgical modality for these patients. In the current landscape, the utilization of minimally invasive surgery (MIS) techniques, such as video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS), has gained widespread popularity for early-stage and locally advanced NSCLC cases, with or without induction chemotherapy, with well-established su ciency and oncological e cacy [10,11]. When compared to traditional thoracotomy, MIS approaches are associated with less surgical-related pain, fewer postoperative comorbidities, faster recoveries, and comparable long-term survivals [12][13][14][15].…”