Propensity-score adjusted comparison of pathologic nodal upstaging by robotic, video-assisted thoracoscopic, and open lobectomy for non–small cell lung cancer

Robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy

“…Kneuertz et al [24] recently published a propensity-score adjusted comparison of lymph node upstaging by RATS, VATS, and open surgery during lobectomy for a cN0/N1 NSCLC in two centers. Between 2011 and 2018, 911 patients were included (254 RATS, 296 VATS, and 261 open surgery).…”

Commentary: Do we have the right combatants? Should it be minimally invasive surgery versus therapy that removes no lymph nodes?

“…Until we all do this consistently, we fail to actualize the true benefit of surgery. For all these reasons, I appreciate the well-done study by Kneuertz and colleagues 1 and congratulate them on this important article. I wonder, however, are the correct combatants in the ring?…”

“…In this issue of the Journal, Kneuertz and associates 1 have reported a 2-institution study comparing lymph node upstaging by means of different surgical platforms: thoracotomy, video-assisted thoracoscopic surgery (VATS), and robotic surgery. The study is well done, and the data and statistics are also well done; however, the question asked cannot be answered by this study, nor will it be by any study soon.…”

“…Unfortunately, these 3 staging initiatives were not routinely performed or applied in a standardized manner in the study of Kneuertz and associates. 1 As minimally invasive surgical thoracic techniques improve and more patients across the world are able to get it routinely, the true incidence of upstaging needs to be shown, as well as its true value.…”

Directions for robotic surgery in the treatment of thoracic diseases in Brazil

“…Studies with longer follow-up periods have reported oncological results similar to those obtained with thoracotomy and video-assisted surgery. (9) Kneuertz et al (10) suggested that the robotic technique is more well suited to mediastinal lymphadenectomy than is the video-assisted technique, which gives the former a great oncological advantage.…”