Early Outcomes After Robotic- Versus Video-Assisted Thoracic Surgery for Early-Stage Lung Cancer

Patient-reported outcomes (PROs) help identify perceived differences after similar surgical interventions. This study aimed to compare early patient-reported and clinical outcomes between multiportal robotic-assisted thoracic surgery (M-RATS) and multiportal video-assisted thoracic surgery (M-VATS) for early-stage lung cancer undergoing either lobectomy or sublobar resection.

Data were collected from an ongoing longitudinal cohort study (CN-PRO-Lung 3, a study designed to evaluate patient-reported outcomes in lung surgery), and PROs were assessed using the Perioperative Symptom Assessment Scale for Lung Surgery at baseline, daily during postsurgery hospitalization, and daily postdischarge for 30 days. The proportion of moderate-to-severe symptom and functional scores on the 0-10-point scales was compared between M-RATS and M-VATS using generalized estimation equation models.

Of the 198 included patients, 106 (53.5%) and 92 (46.5%) underwent M-RATS and M-VATS, respectively. After adjustment, the M-RATS group showed significantly fewer patients with moderate-to-severe composite scores of the seven symptom items (36.8% vs. 46.5%; relative risk, 0.44; 95% confidence interval [CI], 0.28-0.69; P = 0.0003) and two functional items (38.5% vs. 49.2%; relative risk, 0.45; 95% CI, 0.30-0.70; P = 0.0003), compared with the M-VATS group, during postoperative days 1-4. No significant differences were observed between the groups during the 1-30-day postdischarge period. Patients undergoing M-RATS had a shorter operative time (P = 0.001), lower operative blood loss (P < 0.001), more stations (P = 0.029), more (P = 0.001) harvested lymph nodes, but higher cost (P < 0.001) compared with those undergoing M-VATS.

During the early postoperative period for early-stage lung cancer, patients undergoing M-RATS may experience reduced symptom burden, improved functional status, and better clinical outcomes compared with those undergoing M-VATS, although these advantages for PROs may not be sustained after discharge.