Validation of robotic resection without preoperative diagnosis for peripheral clinical T1N0 lung cancer

To evaluate safety, accuracy, and cost-efficiency of robotic thoracoscopic diagnostic wedge and immediate anatomic resection without preoperative diagnosis of peripheral nodules suspicious of cT1N0 lung cancers.

We queried our robotic thoracic surgery institutional database (January 1, 2017, to December 31, 2025) to identify patients with cT1N0 tumors amenable to intraoperative wedge for cancer diagnosis and immediate curative-intent anatomic resection. Data included demographics, preoperative biopsy, operative details, postoperative outcomes, Mayo Clinic cancer score, and estimated costs associated with cancer diagnosis and resection.

In total, 786 patients were included in this study; 585 patients (including 65 having nondiagnostic preoperative biopsy) underwent diagnostic wedge resection: 100 (17.1%) benign and 485 (82.9%) malignant diagnosis. A total of 467 had anatomic resections (1-stage diagnosis and therapy, group 1); 266 patients had preoperative biopsy, with definite cancer diagnosis in 201 (75.8%) and 197 had anatomic resection (2-stage diagnosis then therapy, group 2), whereas 65 (24.4%) nondiagnostic biopsies required subsequent diagnostic resection, and 118 patients had wedge resection only (group 3). Three groups had similar preoperative characteristics. Larger tumors, more lobectomy, and greater incidence of nodal upstaging and costs were observed in group 2. Discordance between intraoperative and postoperative pathology was noted in 11 (2.3%) of 485 patients, with 9 having a history of carcinoma. No complications were reported in 88.6%, 83.7%, and 94.1% of patients in groups 1, 2, and 3, respectively.

1-stage robotic resection is a safe, accurate, and cost-efficient strategy in this patient population. Preoperative biopsy is useful in patients with a previous history of carcinoma to minimize diagnostic discordance associated with under/over-treatments.