Short- and long-term outcomes of robotic-assisted versus video-assisted thoracoscopic lobectomy in non-small cell lung cancer patients aged 35 years or younger: a real-world study with propensity score-matched analysis

Abstract

Purpose This study compared short- and long-term outcomes of robotic-assisted thoracoscopic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for lobectomy in young adults aged ≤ 35 years with non-small cell lung cancer (NSCLC), aiming to assess the superiority of RATS over VATS for this special group of patients. Methods A total of 1355 consecutive NSCLC cases aged 18–35 years undergoing RATS (n = 105) or VATS (n = 1250) between 2014 and 2021 were retrospectively identified from a prospectively maintained database. Propensity score matching (PSM) was applied to establish a 1:3 RATS versus VATS ratio. Baseline clinicopathological characteristics, perioperative outcomes, lymph node (LN) assessment, and long-term survival were investigated. Results Following PSM, 105 and 315 cases were in the RATS and VATS groups, respectively. RATS led to a shorter postoperative hospital stay than VATS (4.0 ± 1.5 vs 4.3 ± 1.7 days, p = 0.02). The two groups were comparable in other perioperative outcomes and postoperative complications (all p > 0.05). Moreover, RATS assessed more LNs (9.4 ± 4.4 vs 8.3 ± 3.6, p = 0.03), especially N1 LNs (4.2 ± 3.1 vs 3.5 ± 2.2, p = 0.02), than VATS. By comparison, no difference in 5-year recurrence-free survival (RFS), overall survival (OS), or recurrence or mortality patterns was found between the two groups (all p > 0.05). Further subgroup analyses also observed similar long-term outcomes between the two groups regarding age, gender, and smoking history. Finally, Cox’s analyses found that the surgical approach was not independently correlated with RFS or OS. Conclusion RATS shortened postoperative hospital stay, assessed more N1 and total LNs, and achieved comparable long-term outcomes to VATS for very young NSCLC patients.

Robotic Versus Thoracoscopic Sub-lobar Resection for Octogenarians with Clinical Stage IA Non-small Cell Lung Cancer: A Propensity Score-Matched Real-World Study

“…The superiority of RATS over VATS in reducing intraoperative blood loss might be attributable to the advantages offered by the robot-assisted surgical system, including a 3D, high-definitional surgical view and robotic arms with exceptional maneuverability, dexterity, and stability. 3 , 21 , 28 These features mitigate the natural hand tremors, enabling surgeons to perform more precise anatomic dissections of blood vessels and bronchi, thereby avoiding unnecessary damage and excessive bleeding. Nevertheless, bleeding control is a significant benefit of sub-lobectomy over lobectomy, and patients undergoing MIS sub-lobar resection are commonly associated with minimal blood loss.…”

“…The da Vinci Surgical System is among the most advanced, complex, and costly pieces of surgical equipment globally, offering several inherent advantages, including a 3D, high-definition, and 10-fold magnified surgical view as well as robotic arms with full rotational capability within the chest cavity. 3 , 20 , 39 These features provide exceptional maneuverability and enhanced dexterity compared with traditional two-dimensional VATS techniques, providing surgeons with enhanced convenience when dissecting LNs, particularly mediastinal LNs, which may be challenging to assess using VATS due to its limited flexibility. This may clarify the rise in the proportion of patients undergoing RATS wedge resection who underwent the mediastinal LN assessment.…”

“… 1 , 2 With the increasing prevalence of thin-section thoracic computed tomography (CT) screening and improvements in diagnostic methods, the early diagnosis rate for early-stage small NSCLC has risen sharply. 3 …”

“…In recent years, robot-assisted thoracoscopic surgery (RATS), an innovative MIS approach first introduced to the thoracic surgical field in 2002, has become increasingly prevalent. 3 , 7 , 20 The robot-assisted surgical system possesses a high-quality, three-dimensional (3D), 10-fold magnified surgical view as well as highly flexible, maneuverable, and stable robot arms, providing operators with great convenience in performing surgical resection and thus notably reducing unnecessary injury. 3 , 21 Given these characteristics, RATS may be a more suitable approach than VATS for very old patients who frequently experience postoperative complications, slow recoveries, and poor outcomes.…”

Analyzing robotic surgery impact on recovery quality & emotions

“…This can also lead to depression and anxiety, ultimately affecting the quality of postoperative rehabilitation. Numerous studies [ [1] , [2] , [3] , [4] , [5] ] have demonstrated that RATS offers significant advantages over VATS in terms of surgical treatment and long-term survival [ 6 ]. However, as the medical model undergoes transformation, patient expectations for disease management extend beyond the relief of postoperative pain and the restoration of physiological function.…”