Evaluating Surgical Approaches in Early NSCLC: A Meta-Analysis of Robot-Assisted and Video-Assisted Techniques

Lung cancer, especially non-small cell lung cancer (NSCLC), is a leading cause of cancer death. Surgical resection is the primary treatment for early-stage NSCLC. Video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracic surgery (RATS) are minimally invasive options, with RATS offering better precision at higher costs. This meta-analysis compared the perioperative outcomes of both techniques in NSCLC.

A systematic search in PubMed, Web of Science, NLM, CNKI, and Wanfang was conducted for RCTs published between 31 July 2021 and 31 December 2024. Primary outcomes included operation time, blood loss, lymph node dissection, conversion to thoracotomy, chest drainage time, and hospital stay. Statistical analyses were performed using RevMan 5.3, with heterogeneity assessed using the I² statistic. A p value lower than 0.05 was considered significant.

Three RCTs were analyzed. Blood loss showed no significant difference between VATs and RATs (mean difference [MD], -33.00; 95% CI, -85.51 to 22.89; p = 0.07). Conversion to thoracotomy was comparable (MD, 0.69; 95% CI, 0.37 to 1.28; p = 0.24). Hospital stay did not differ significantly (MD, 0.13; 95% CI, -0.58 to 0.84; p = 0.74). Operation time remained similar (MD, -4.63; 95% CI, -10.93 to 1.67; p = 0.15). The VATS procedure enabled significantly greater lymph node dissection (MD, 1.83; 95% CI, 0.16 to 3.49; p = 0.03). Chest drainage duration showed no difference (MD, 0.00; 95% CI, -0.27 to 0.27; p = 1.00).

In NSCLC, RATS and VATS yield comparable outcomes, with RATS potentially reducing blood loss and VATS allowing more lymph node dissection. Further high-quality RCTs are needed to clarify the optimal approach for NSCLC.