Mortality for Robotic- vs Video-Assisted Lobectomy-Treated Stage I Non-Small Cell Lung Cancer Patients.

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Minimally Invasive Procedures

Background:

• US FDA safety concerns regarding robotic surgery necessitate comparative outcome analyses.
• Stage I non-small cell lung cancer (NSCLC) is frequently treated with lobectomy.
• Robotic-assisted thoracoscopic surgical lobectomy (RATS-L) and video-assisted thoracoscopic surgical lobectomy (VATS-L) are common minimally invasive approaches.

Purpose of the Study:

• To compare short- and long-term mortality between RATS-L and VATS-L for stage I NSCLC.
• To evaluate the impact of tumor size on mortality differences between RATS-L and VATS-L.
• To provide evidence for clinical decision-making in NSCLC surgical treatment.

Main Methods:

• Analysis of 18,908 stage I NSCLC patients from the National Cancer Database (2010-2014).
• Comparison of RATS-L versus VATS-L using Cox proportional hazards models.
• Propensity score-matched and unmatched analyses to estimate mortality hazard ratios (HRs).

Main Results:

• RATS-L showed higher 90-day mortality than VATS-L when conversion to open thoracotomy occurred (6.6% vs 3.8%).
• For tumors ≤20mm, RATS-L was associated with increased long-term mortality (HRs ranging from 1.17 to 1.36) in intention-to-treat analyses.
• No significant mortality difference was observed for tumors >20mm or in patients without conversion to open surgery.

Conclusions:

• Patients with small (≤20mm) stage I NSCLC treated with RATS-L face a statistically significant higher long-term mortality risk compared to VATS-L.
• The increased mortality risk with RATS-L for small tumors persists beyond the first year post-surgery.
• Findings highlight the importance of considering surgical approach based on tumor characteristics and potential conversion risks.