Efficacy of the da Vinci robot versus thoracoscopic surgery for patients with mediastinal tumors of different body mass index: a multicenter propensity score-matched study

Abstract Background. The purpose of present study was to evaluate the efficacy and safety of Da Vinci robot-assisted thoracoscopic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for the treatment of patients with mediastinal tumors of different body mass indices (BMI). Methods. A retrospective cohort study was used to collect 260 patients with mediastinal tumors admitted to three medical centers in China from December 2020 to December 2023. These patients underwent mediastinal tumor resection by RATS (n=125) or VATS (n=135). Propensity score matching (PSM) analysis was performed for both groups, and further, the patients were divided into N-BMI group (18.5 kg/m2≤BMI<25 kg/m2) and H-BMI group (BMI≥25 kg/m2) based on their BMI to compare patients’ surgery-related information. Results. The RATS group was more advantages in terms of intraoperative blood loss, total postoperative drainage, postoperative drainage time, and postoperative hospital stay. In terms of hospitalization costs, the VATS group was more advantageous. Subgroup analysis showed that in the H-BMI group, in addition to obtaining similar findings as before the subgroup analysis, we found a statistically significant difference in shorter operative time and lower incidence of postoperative complications in the RATS group. Conclusion. Compared to VATS, RATS has technical and short-term efficacy advantages, although it has the drawback of high costs associated with the treatment of mediastinal tumors. In patients with mediastinal tumors of high BMI, RATS can achieve better short-term outcomes and safety, especially in terms of reducing the incidence of postoperative complications.