Comparative study of anatomic lung resection by robotic vs. video-assisted thoracoscopic surgery

Comparative studies of robotic lung resection are limited. Our study aims to compare short-term and long-term outcomes of anatomic lung resection by robotic or video-assisted thoracoscopic surgery (VATS) from a single surgeon experienced in both approaches.

A retrospective analysis of consecutive anatomic lung resections by robot or VATS was performed to compare perioperative characteristics and long-term survival.

From December 2010 to June 2015, 61 patients underwent robotic surgery, and 105 patients underwent VATS. Patient demographics were similar except that the VATS group had higher percentage of diabetic patients (robotic 14.75% vs. VATS 30.48%, P=0.0258) and a slightly lower percentage of patients with previous cancer history (robotic 57.38% vs. VATS 40.95%, P=0.0409). The robotic group had a higher rate of prolonged air leak ≥7 d (robotic 14.75% vs. VATS 3.81%; P=0.0161), and a modestly longer length of hospital stay (robotic median of 4.0 days vs. VATS median of 3.0 days, P=0.0123). Other postoperative complications, mortality, nodal upstaging and conversion rate were similar. Disease-free survival was not different. The robotic group appeared to have slightly better overall survival, however, this observation was confounded by a lower percentage of diabetic patients in this group. Further analysis has demonstrated that in non-diabetic patients who underwent either surgery, the overall survival remained similar. The same observation was also made in diabetic patients.

Robotic anatomic lung resection appears to be associated with a higher rate of prolonged air leak (≥7 d), and resulting slightly longer length of hospital stay than VATS. Within the same follow-up period, both the disease-free survival and the overall survival are similar.