Perioperative Outcomes in Robotic vs Video-Assisted Thoracoscopic Surgery for Complex Lung Cancer Operations

Introduction: The adoption of minimally invasive approaches for complex lung cancer resections remains challenging with current literature limited to small case series. We compared perioperative outcomes between robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) in patients with locally advanced non-small cell lung cancer (NSCLC) who underwent complex or extended lung resections using the National Cancer Database. Methods: We identified NSCLC patients undergoing minimally invasive bronchial sleeve resection, pneumonectomy, or extended lobectomy involving the pericardium, chest wall, or diaphragm during 2010-2018. We investigated the impact of surgical approach on various outcomes of interest while controlling for sociodemographic, clinical, and facility characteristics. Results: We identified 2,867 patients. These included 2,336 (81.5%) and 531 (18.5%) patients who underwent VATS and RATS resection, respectively. During 2010-2018, the percentage use of RATS increased (10.3% to 26.5%), while the percentage use of VATS decreased (89.7% to 73.5%), p < 0.01. RATS was associated with a shorter median hospital stay (5 vs 6 days, p = 0.01), while VATS was associated with a higher odds of conversion [adjusted odds ratio:1.49, p < 0.01]. There was no significant difference between the two approaches in terms of surgical margins status, number of regional lymph nodes examined, pathologic nodal upstaging, 90-day mortality, or 30-day unplanned readmission, p>0.05. Conclusion: Complex or extended resections for lung cancer performed via RATS are becoming more frequent and are associated with similar peri-operative outcomes as those performed via VATS. Notable differences included a lower likelihood of conversion and a shorter hospital stay in patients undergoing RATS operations.