Short-term outcomes of robot-assisted versus video-assisted thoracoscopic surgery for non-small cell lung cancer patients with neoadjuvant immunochemotherapy: a single-center retrospective study

Abstract

BackgroundNeoadjuvant immunochemotherapy has been increasingly applied to treat non-small cell lung cancer (NSCLC). However, the comparison between robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) in the feasibility and oncological efficacy following neoadjuvant immunochemotherapy is scarce. This study aims to assess the superiorities of RATS over (VATS) concerning short-term outcomes in treating NSCLC patients with neoadjuvant immunochemotherapy.MethodsNSCLC patients receiving RATS or VATS lobectomy following neoadjuvant immunochemotherapy at Shanghai Chest Hospital from 2019 to 2022 were retrospectively identified. Baseline clinical characteristics, perioperative outcomes, and survival profiles were analyzed.ResultsForty-six NSCLC patients with neoadjuvant immunochemotherapy were included and divided into the RATS (n=15) and VATS (n=31) groups. The baseline clinical characteristics and induction-related adverse events were comparable between the two groups (all p>0.050). The 30-day mortality in the RATS and VATS groups were 0% and 3.23%, respectively (p=1.000). Patients undergoing RATS were associated with reduced surgical-related intensive unit care (ICU) stay than those receiving VATS (0.0 [0.0-0.0] vs. 0.0 [0.0-1.0] days, p=0.026). Moreover, RATS assessed more N1 LNs (6.27 ± 1.94 vs 4.90 ± 1.92, p=0.042) and LN stations (3.07 ± 1.03 vs 2.52 ± 0.57, p=0.038) compared with VATS. By comparison, no difference was found in surgical outcomes, pathological results, and postoperative complications between the RATS and VATS groups (all p>0.050). Finally, RATS and VATS achieved comparable one-year recurrence-free survival (82.96% vs. 85.23%, p=0.821) and the timing of central nervous system, LN, and bone recurrences (all p>0.050).ConclusionRATS is safe and feasible for NSCLC patients with neoadjuvant immunochemotherapy, reducing surgical-related ICU stay, assessing increased N1 LNs and stations, and achieving similar survival profiles to VATS.

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

“…Continuous variables were presented as either mean ± standard deviation (SD) or as median and interquartile range (IQR), while categorical variables were expressed as frequencies and percentages. [11][12][13][14][15][16][17][18][19][20] vs. 12 [9][10][11][12][13][14][15], P=0.007). The two groups were comparable concerning the surgical duration, R0 resection, blood transfusion, chest tube volume, postoperative hospitalization, and dissected LN stations (all P>0.050).…”

“…Importantly, as experience accumulates and surgical pro ciency improves, MIS techniques are increasingly adopted for NSCLC patients after induction immunochemotherapy. Recent publications suggest that MIS achieved low surgical-related mortality and morbidity, along with an acceptable conversion rate [9,[16][17][18][19]. A recent study rea rms these ndings, indicating that VATS outperforms thoracotomy regarding surgical-related outcomes and postoperative recovery while achieving survival outcomes on par with thoracotomy [20].…”

“…MIS and open lobectomy were performed based on established methodologies as previously documented [19,21,22]. All patients underwent general intravenous (i.v.)…”

Tackling complex thoracic surgical operations with robotic solutions: a narrative review

“…Similarly, a 2023 study compared 46 NSCLC patients who underwent neoadjuvant immunochemotherapy followed by surgery, dividing them into 15 robotic and 31 VATS cases ( 58 ). The robotic group exhibited no 30-day mortality along with reduced ICU stay.…”