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Does Robotic Surgery Offer Advantages Over Thoracoscopic Surgery for Patients Undergoing Wedge Resection for
Grace Ha1, Lesley Coe1, Rajika Jindani1
1Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, 10467, United States.
Summary
Robotic-assisted thoracoscopic surgery (RATS) for lung wedge resection yields more lymph nodes, potentially improving survival. However, differences in surgical outcomes and mortality were not significant compared to video-assisted thoracoscopic surgery (VATS).
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Minimally Invasive Procedures
Background:
- Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are standard minimally invasive techniques for non-small cell lung cancer (NSCLC).
- The benefits of RATS for simple wedge resections, compared to VATS, remain unclear.
Purpose of the Study:
- To compare outcomes between RATS and VATS for minimally invasive wedge resection in clinical stage IA NSCLC patients.
- To evaluate the impact of lymph node yield on survival following wedge resection.
Main Methods:
- Analysis of the National Cancer Database (NCDB) from 2010-2022.
- Inclusion of patients with clinical stage IA NSCLC undergoing minimally invasive wedge resection.
- Comparison of outcomes between RATS and VATS, including lymph node yield, nodal upstaging, adjuvant therapy, surgical margins, length of stay, readmissions, and mortality.
Main Results:
- RATS (26.8%) was associated with significantly higher lymph node yield compared to VATS (73.2%).
- RATS showed higher odds of nodal upstaging and increased delivery of adjuvant therapy.
- No significant differences were found in surgical margins, length of stay, readmissions, or short-term mortality between RATS and VATS.
- Increased lymph node sampling was linked to a slight improvement in 5-year overall survival.
Conclusions:
- Robotic-assisted thoracoscopic surgery (RATS) for wedge resection increases lymph node yield, potentially contributing to improved overall survival.
- While RATS demonstrated benefits in lymph node sampling and nodal upstaging, overall survival improvements were modest.
- Further research is needed to distinguish the specific contributions of RATS adoption versus general advancements in oncologic care and to assess cost-effectiveness.
