National adoption of robotic-assisted thoracoscopic surgery for oncologic lung resections

The objective of this study is to analyze national trends in the adoption of robotic-assisted thoracoscopic surgery (RATS) for lung cancer resections compared to video-assisted thoracoscopic surgery (VATS) and open approaches across geographic regions and institution types in the National Cancer Database (NCDB). A retrospective cohort study was performed of adults who underwent a lung resection for non-small cell lung cancer between 2010 and 2021 in the NCDB. Data were stratified by facility type, surrounding area population, and geographic location. Multivariable logistic regressions with interaction terms were used to determine if the change in rates of RATS varied by facility type, surrounding population, and location. A total of 301,123 oncologic lung resections were included in this study. The total number of RATS surpassed VATS in 2019, with 9579 and 9454 cases, respectively. By 2021, RATS accounted for 65.4% of minimally invasive cases. Academic programs were found to be increasing the proportion of their RATS resections at a faster rate than community programs. Facilities in metropolitan settings are adopting robotic resections at a more rapid rate than in urban and rural areas. The rate of RATS adoption varied significantly by region, with the East South-Central region having the slowest adoption rate. In contrast, the South Atlantic and East North-Central regions experienced the highest rate of increase in RATS adoption. RATS for oncologic lung resection is increasing and has surpassed VATS and open resections as of 2019. RATS resections are growing most rapidly in academic and metropolitan programs, and in certain geographic regions.