Does robotic surgery influence time to surgery and outcomes in stage I-II non-small cell lung cancer?

Abstract

Robotic-assisted surgery is increasingly used for early stage non-small cell lung cancer resection, yet its impact on time to surgery and outcomes remains unclear. Using the National Cancer Database (2010-2022), adults with clinical stage I-II non-small cell lung cancer who underwent initial resection by open, video-assisted thoracoscopic surgery, or robotic-assisted surgery were identified for a retrospective cohort study. Prolonged time to surgery was defined as surgery >8 weeks after diagnosis. Multivariable logistic regression identified factors associated with longer time to surgery and short-term outcomes, such as length of hospital stay, 30-day readmission, and 30-/90-day mortality. Overall survival was assessed using Kaplan-Meier analysis, and Cox hazards regression evaluated adjusted hazard of death in robotic cases. Among 173,170 patients, 22.9% experienced longer time to surgery. Robotic-assisted surgery, academic centers, non-White race, nonprivate insurance, and lower socioeconomic status were independently associated with increased time to surgery. Across all patients, increased time was independently associated with higher 30-day mortality and 90-day mortality. While robotic-assisted surgery was associated with higher odds of longer time to surgery, it was independently associated with lower 30-day and 90-day mortality. Within the robotic subgroup, longer time to surgery was independently associated with increased 90-day mortality and worse overall survival. Robotic resection is associated with favorable short-term outcomes but more frequent longer time-to-surgery intervals and worse overall survival. Targeted strategies to reduce time to surgery in robotic-assisted surgery are warranted.