Comparison of Robot-Assisted Versus Video-Assisted Thoracoscopic Segmentectomy: A Single-Institution...

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Robot-assisted thoracoscopic segmentectomy (RVATS) and video-assisted thoracoscopic segmentectomy (VATS) are established techniques for lung cancer resection.
• Previous studies have explored the feasibility of RVATS versus VATS, but comprehensive outcome comparisons are limited.

Purpose of the Study:

• To compare short-term and long-term oncological and perioperative outcomes of RVATS and VATS for primary non-small cell lung cancer (NSCLC).

Main Methods:

• Retrospective propensity-matched cohort study of 108 RVATS and 370 VATS procedures for primary NSCLC (2013-2021).
• 1:2 propensity matching created matched cohorts of 102 RVATS and 204 VATS patients.
• Outcomes analyzed included mortality, readmission, morbidity, lymph node yield, operative time, margin status, and survival.

Main Results:

• No significant differences in 90-day mortality, 30-day readmission, or median lymph nodes harvested.
• RVATS demonstrated a greater median number of lymph node stations harvested and wider negative tumor margin distance.
• Postoperative morbidity was similar, except for a higher rate of pleural effusion in RVATS.
• All patients achieved R0 resection; 3-year disease-free and overall survival rates were comparable between groups.

Conclusions:

• RVATS facilitates harvesting more lymph node stations and achieving a greater negative tumor margin distance.
• These benefits of RVATS can be achieved without compromising short-term perioperative or long-term oncological outcomes in NSCLC segmentectomy.
• RVATS represents a valuable advancement for lung cancer segmentectomy, enhancing surgical precision and oncological clearance.