Nationwide Assessment of Robotic Lobectomy for Non-Small Cell Lung Cancer

Robotic lobectomy has been described for non-small cell lung cancer (NSCLC). Our objectives were to (1) evaluate the use of robotic lobectomy over time, (2) identify factors associated with its use, and (3) assess outcomes after robotic lobectomy compared with other surgical approaches.

Stage I to IIIA NSCLC patients were identified from the National Cancer Data Base (2010 to 2012). Trends in robotic lobectomy were assessed over time, and multivariable logistic regression models were developed to identify factors associated with its use. Propensity-matched cohorts were constructed to compare postoperative outcomes after robotic lobectomy with thoracoscopic and open lobectomy.

Lobectomy was performed in 62,206 patients by open (n = 45,527), thoracoscopic (n = 12,990), or robotic (n = 3,689) procedures at 1,215 hospitals. Between 2010 and 2012, robotic lobectomy significantly increased, from 3.0% to 9.1% (p < 0.001). Academic (odds ratio, 1.55; 95% confidence interval, 1.04 to 2.33) and high-volume hospitals (odds ratio, 1.49; 95% confidence interval, 1.04 to 2.14) were associated with increased use of robotic lobectomy. Length of stay was shorter in robotic lobectomy compared with open lobectomy (6.1 vs 6.9 days; p < 0.001). Fewer lymph nodes (9.9 vs 10.9; p < 0.001) and 12 or more nodes were examined less frequently (32.0% vs 35.6%; p = 0.005) in robotic resections than in thoracoscopic resections. There was no difference between robotic and open or robotic and thoracoscopic lobectomy patients in margin positivity, 30-day readmission, and deaths at 30 and 90 days.

Robotic lobectomies have significantly increased in stage I to IIIA NSCLC patients, with outcomes similar to other approaches. Additional studies are needed to determine if this technology offers potential advantages compared with video-assisted thoracoscopic operations.