Perioperative Outcomes of Robotic- vs Video-Assisted Thoracoscopic Surgery in Non-Small Cell Lung Cancer After Neoadjuvant Therapy.

Abstract

This study compared perioperative outcomes between robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) in non-small cell lung cancer (NSCLC) patients after neoadjuvant therapy. We retrospectively analyzed 939 NSCLC patients (2021-2023), including 816 VATS and 123 RATS cases. A 1:2 propensity score-matching method was adopted to create a balanced cohort, including 246 with VATS and 123 with RATS. Demographic characteristics, neoadjuvant therapy efficacy, and perioperative outcomes were compared. Subgroup analysis evaluated RATS benefits in sleeve lobectomy, and logistic regression identified risk factors for postoperative complications. After matching, RATS showed lower thoracotomy conversion rates (3.1% vs 8.9%, P = .044), greater lymph node dissection (stations: 7 [interquartile range {IQR}, 6-8] vs 5 [IQR, 5-6.25]; numbers: 18 [IQR, 14-26] vs 14 [IQR, 10-20]; both P < .001), reduced blood loss (50 mL [IQR, 50-100 mL] vs 50 mL [IQR, 50-100 mL], P = .048), shorter operative time (124 minutes [IQR, 110-170 minutes] vs 130 minutes [IQR, 117-184 minutes], P = .041), and shorter chest tube duration (4 days [IQR, 3-5 days] vs 5 days [IQR, 3-6 days], P = .002). Persistent air leak >7 days was less frequent with RATS (1.6% vs 7.7%, P = .017). In sleeve lobectomy, RATS further reduced operative time (150 minutes [110-200.5 minutes] vs 197.5 minutes [147.25-238.5 minutes], P = .003) and chest tube duration (4 days [3-6 days] vs 5 days [4-6 days], P = .014). Multivariable logistic regression analyze shows prolonged operative time (odds ratio, 1.014; 95% CI, 1.008-1.020; P < .001) and pneumonectomy (odds ratio, 4.866; 95% CI 1.236-19.158; P = .024) independently predicted complications. RATS is associated with more favorable perioperative outcomes compared with VATS in NSCLC after neoadjuvant therapy, especially associated with significantly reduced operative time, blood loss, and chest tube duration in sleeve lobectomy, suggesting its potential utility for complex resections.