Clinical Outcomes in Non-Small Cell Lung Cancer Among Sustained Adopters of Robotic Thoracic Surgery

The adoption of the robotic platform in thoracic surgery has increased within the last decade. We aim to compare clinical outcomes among facilities that performed lung resections for patients with non-small lung cancer (NSCLC) preadoption and postadoption of robotic surgery.

A retrospective case-control analysis was conducted using the National Cancer Database from 2010 through 2021. Facilities that performed ≥90% of robotic lung resections for at least 2 consecutive years in 2016 or afterward were deemed sustained adopters. Time periods for facilities were categorized by pretransition (<50% use), transition (50%-90%), and posttransition (≥90%). Primary (30- and 90-day mortality) and secondary outcomes (30-day readmission, robot-to-open conversion, margin positivity, mean lymph nodes sampled, and pathological upstaging) were analyzed preadoption and postadoption.

Within our cohort, 57 facilities met criteria with 24,909 cases. Of these, 12,181 occurred in the pretransition period (robotic use [RU], 8.6%), 7440 in the transition period (RU, 79.6%), and 5288 in the posttransition period (RU, 93.6%). Compared with control facilities, a greater proportion of study facilities experienced decreases in 30-day (70% vs 63.2%) and 90-day mortality (72.5% vs 52.6%) posttransition. A smaller proportion of study facilities showed decreases in mean lymph nodes sampled (17.5% vs 38.2%) and pathologic upstaging (23.2% vs 40.7%) compared with control facilities.

Facilities that sustained adopted robotic surgery may be associated with decreased short-term mortality rates and higher rates of lymph nodes sampled and pathologic upstaging. Continued uptake of robotic platforms in thoracic surgery is not only safe but may also provide mortality and oncologic benefit.