Current state of evidence for RATS lobectomy for NSCLC

Robot-assisted thoracic surgery (RATS) has progressively been integrated into minimally invasive strategies for pulmonary lobectomy in patients with non-small cell lung cancer (NSCLC). Although video-assisted thoracic surgery (VATS) remains the most established minimally invasive approach, the clinical relevance and added value of robotic platforms continue to be debated.

This narrative review critically examines the existing literature on robot-assisted lobectomy for NSCLC. Emphasis is placed on comparative data evaluating oncological outcomes, lymph node assessment, perioperative results, technical considerations, learning curve, and economic implications in relation to VATS and open surgery.

Available evidence, predominantly derived from retrospective studies and large database analyses, indicates that RATS lobectomy is feasible and safe when performed in experienced centers. Long-term oncological outcomes, including overall and disease-free survival, appear broadly comparable across surgical approaches. While some studies suggest that robotic assistance may facilitate more extensive lymph node assessment, the clinical significance of these findings remains uncertain. Perioperative outcomes such as conversion rates, postoperative morbidity, and length of hospital stay are generally similar between RATS and VATS. Higher procedural costs associated with robotic platforms remain a consistent concern, with cost-effectiveness strongly influenced by institutional volume and resource allocation.

Current evidence supports RATS lobectomy as a valid minimally invasive option for selected patients with NSCLC, offering outcomes comparable to those of established techniques. Despite clear technical advantages, definitive clinical superiority has not been demonstrated, highlighting the need for further prospective studies and standardized outcome reporting.