The Safety of Robotic Pneumonectomy

Pneumonectomy remains among the most morbid procedures in thoracic surgery. Increasingly, robotic approaches are being adopted for a range of thoracoscopic procedures. The safety profile of robot-assisted thoracoscopic pneumonectomy remains poorly described, as do outcomes compared with traditional approaches.

The National Cancer Database was used for a retrospective cohort analysis for patients with non-small cell lung cancer undergoing pneumonectomy from 2014 to 2018. Robotic approach was compared with open and thoracoscopic pneumonectomy. Descriptive and outcomes analyses, and 5-year overall survival were assessed.

Robot-assisted approach was completed in 269 (5.56%) cases, 3671 (75.88%) by open resection, and 898 (18.56%) thoracoscopically. Compared with open, robotic procedures resulted in similar median lymph node harvests (15 nodes vs 16 nodes; P = .52), rates of R0 resections (89.1% vs 89.1%; P = .99), and shorter median length of stay (5 days vs 6 days; P < .001). Similarly, robotic procedures had no significant clinical differences in quantity of lymph nodes examined, R0 resection rates, and length of stay compared with minimally invasive pneumonectomies. No differences were noted in 5-year overall survival between robotic (55.33%), open (50.24%), and minimally invasive (49.82%) pneumonectomies (P = .52).

Robot-assisted pneumonectomy can be performed safely in the setting of appropriate oncologic indications. Patients have comparable rates of R0 resection, nodal harvest, and survival compared with those treated with an open or thoracoscopic approach.