Comparing Robotic, Thoracoscopic, and Open Segmentectomy: A National Cancer Database Analysis

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Segmentectomy is oncologically equivalent to lobectomy for early-stage non-small cell lung cancer (NSCLC).
• Comparative outcome data for different surgical approaches to segmentectomy are limited.
• Minimally invasive techniques like VATS and robotic surgery are increasingly adopted for lung resections.

Purpose of the Study:

• To compare outcomes of robotic, video-assisted thoracoscopic surgery (VATS), and open segmentectomy for NSCLC.
• To identify predictors of 30-day readmissions, 90-day mortality, and overall survival after segmentectomy.
• To evaluate the impact of surgical approach on patient outcomes using the National Cancer Database.

Main Methods:

• Retrospective analysis of clinical stage I NSCLC patients undergoing segmentectomy (2010-2016).
• Propensity-score matching (1:4:1) to balance patient characteristics across surgical approaches.
• Multivariate logistic regression to analyze 30-day readmissions, 90-day mortality, and overall survival.

Main Results:

• An open approach was linked to significantly higher 30-day readmissions and 90-day mortality compared to VATS and robotic approaches.
• Robotic segmentectomy demonstrated superior 5-year survival rates compared to both VATS and open surgery.
• VATS approach showed lower 30-day readmission and 90-day mortality rates than the open approach.

Conclusions:

• For early-stage NSCLC segmentectomy, VATS and robotic approaches are associated with better short-term outcomes than open surgery.
• Robotic surgery may offer improved long-term survival benefits compared to VATS and open procedures.
• Further research is needed to explore potential confounding factors influencing these observed outcome differences.