Wedge Resection Outcomes: A Comparison of Video-Assisted and Robotic-Assisted Wedge Resections

BACKGROUND Quality of oncologic resection for early-stage non-small cell lung cancer (NSCLC) may differ depending on surgical approach. Minimally invasive surgery has become the standard for surgical treatment of NSCLC. Our study compares quality of wedge resection using video-assisted thoracoscopic surgery (VATS) versus robotic video-assisted thoracoscopic surgery (RVATS). We hypothesized that RVATS would result in higher quality resections and improved patient outcomes. METHODS A retrospective cohort analysis was completed utilizing the National Cancer Database for patients with clinical stage 1 NSCLC with tumor size ≤ 2 cm who underwent a minimally invasive surgery wedge resection from 2010-2019. Wedge resections approached with RVATS were compared to VATS. A 1:1 propensity match analysis was performed. RESULTS The cohort included 16,559 patients; 80.4% (13,406) received VATS and 18.9% (3,153) received RVATS. Compared to RVATS, a VATS approach was associated with a lower likelihood of lymph nodes being examined (59.0% vs. 75.2%, p<0.001), was associated with fewer nodes dissected (median: 4 vs. 5, p<0.001), and less adjuvant systemic therapy administered (1.3% vs 2.2%, p<0.001). Propensity matching resulted in 2,590 balanced pairs. Statistical significance was maintained among likelihood of lymph nodes examined, number of nodes dissected, and adjuvant systemic therapy administered. There was no significant difference between nodal upstaging after propensity matching (3.7% vs 4.3% p=0.37). CONCLUSIONS Compared to the VATS approach, wedge resections via RVATS for early-stage non-small cell lung cancer were more likely to be associated with increased lymph nodes resected. This data may support increased utilization of RVATS for wedge resections.