A systematic review and meta-analysis of robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy

O’Sullivan, Katie E.; Kreaden, Usha; Slee, April; Eaton, Donna; Redmond, Karen

doi:10.1093/icvts/ivy315

Cited by 79 publications

(67 citation statements)

References 19 publications

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“…The superiority among RATS, VATS, and open surgery in pulmonary resection remains controversial. Previous meta‐analyses comparing RATS, VATS, and thoracotomy found that RATS had better perioperative outcomes, 9‐11 although these studies were limited to lobectomy/segmentectomy. In addition, data overlapping across different studies may lead to inaccurate results.…”

Section: Introductionmentioning

confidence: 99%

Perioperative outcomes of robot‐assisted vs video‐assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta‐analysis

Chen

Dai

et al. 2020

Robotics Computer Surgery

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Background: The superiority of robot-assisted thoracic surgery (RATS) over videoassisted thoracic surgery (VATS) and thoracotomy remains controversial for lung cancer. Methods: A network meta-analysis (NMA) and pairwise meta-analysis (PMA) were performed to evaluate the perioperative outcomes using five databases. Results: Thirty-two studies involving 6593 patients were included for analysis. The NMA showed that RATS had similar operative time, conversion rate to thoracotomy, number of lymph node, postoperative morbidity, and length of hospital stay with VATS, except for lower 30-day mortality. Compared with thoracotomy, longer operative time and shorter hospital stay were observed in RATS, but no significant difference was observed in number of lymph node, postoperative morbidity, and 30-day mortality in both NMA and PMA. In lobectomy/segmentectomy subgroup, all outcomes, except for operative time of RATS vs VATS and number of lymph node, were similar with overall analyses. Conclusions: RATS had comparable perioperative outcomes with VATS and open surgery.

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Section: Introductionmentioning

confidence: 99%

Perioperative outcomes of robot‐assisted vs video‐assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta‐analysis

Chen

Dai

et al. 2020

Robotics Computer Surgery

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“…However, most meta-analyses reported the same short-term outcomes, with as negative points longer operative times and more costly procedures compared to VATS lobectomy [13,15,[29][30][31][34][35][36]44] . Only O'Sullivan et al [14] reported better short-term outcomes with fewer adverse events after lobectomy by RATS compared to VATS in a systematic review with meta-analysis. Nevertheless, some authors reported in retrospective studies a clear benefit of RATS compared to VATS.…”

Section: Discussionmentioning

confidence: 99%

“…Until the publication of O'Sullivan et al [14] , systematic reviews and meta-analyses [32][33][34][35][36] found small significant differences in short-term outcomes between RATS and VATS lobectomy or no difference between these two minimally invasive surgical approaches.…”

Section: Lymph Node Dissection and Nodal Upstaging By Rats Vats Andmentioning

confidence: 99%

“…Lobectomy for NSCLC involves two steps, namely lung resection and complete lymph node resection, according to international recommendations [1,[4][5][6][7][8][9][10][11][12] . Minimally invasive surgery provides better short-term outcomes compared to open surgery, with fewer adverse events and shorter length of hospital stay [13][14][15] . Until recently, many systematic reviews with meta-analyses and large retrospective databases comparing VATS and RATS lobectomy have provided conflicting results regarding short-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy

Montagne¹,

Bottet²,

Sarsam³

et al. 2020

MIS

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More and more data are available on the benefits of minimally invasive thoracic surgery compared to open thoracic surgery in the curative treatment of early-stage non-small cell lung cancer. However, results are conflicting, especially when video-assisted thoracoscopic surgery (VATS) is compared to robotic-assisted thoracoscopic surgery (RATS) for lobectomy. Our goal is to report the main results of recent systematic reviews and meta-analyses comparing RATS, VATS, and open surgery for lobectomy. Using PubMed database, we selected systematic reviews and meta-analyses, which compared the short-term outcomes of patients treated by RATS, VATS, or open surgery for lobectomy. In all but one of the systematic reviews, robotic lobectomy allowed similar short-term outcomes as VATS lobectomy and better short-term outcomes than open surgery. One meta-analysis by O'Sullivan et al. found that robotic lobectomy was associated with fewer adverse events (P < 0.00001) and lower 30-day mortality (P = 0.001), compared to VATS lobectomy. Robotic lobectomy could be a valid alternative to VATS and open lobectomy. Shortterm outcomes do not appear to be different between VATS and RATS cohorts, except in one recent meta-analysis, which reported the superiority of RATS compared to VATS. Without cost analysis and randomized controlled trials with long-term outcomes, no strong conclusions can be drawn.

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“…According to a recent meta-analysis conducted by O'Sullivan et al [19] , the mortality rate is lower for patients who underwent robotic surgery compared to VATS or Open approaches with an overall protective effect of robotic over thoracotomy [OR: 0.53, 95%CI: 0.33-0.85 (P = 0.008)] and over VATS [OR: 0.61, 95%CI: 0.45-0.83 (P < 0.001)]. Notwithstanding these results should be thoughtfully considered, given that a possible selection bias in robotic cohort may have occurred, data on short-term outcomes of robotic surgery are very interesting.…”

Section: Discussionmentioning

confidence: 99%

Long-term survival of robotic lobectomy for non-small cell lung cancer: a literature review

Ricciardi¹,

Davini²,

Zirafa³

et al. 2020

MIS

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Even though robotic-assisted surgery is increasingly used for resection of non-small cell lung cancer (NSCLC), data on long-term oncologic outcomes of robotic surgery are still not well defined. The primary endpoint of this review is to analyse the long-term results of robotic lobectomy in NSCLC patients. A systematic research was performed using the PubMed We excluded studies that did not provide results for the long-term outcomes of robotic lobectomy, studies that had fewer than 50 cases and ones that focused on results of sub-lobar resections. Therefore, ten eligible studies were included in this analysis. In total, 2873 patients, with a mean age ranging between 66 and 68 years, who underwent robotic lobectomy for NSCLC, were analysed. Most patients (81%) had early-stage disease. The five-year overall survival for stage I disease fluctuated between 77% and 100%. The five-year disease-free survival was reported to be near 73%. We can conclude that robotic assisted lobectomy is an effective minimally-invasive procedure for lung resection. The current literature shows that robotic lobectomy is associated with long-term survival and lasting disease-free survival, equivalent to those reached by video-assisted thoracic surgery and open approach.

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A systematic review and meta-analysis of robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy

Cited by 79 publications

References 19 publications

Perioperative outcomes of robot‐assisted vs video‐assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta‐analysis

Perioperative outcomes of robot‐assisted vs video‐assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta‐analysis

Robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy

Long-term survival of robotic lobectomy for non-small cell lung cancer: a literature review

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