Comparison of Video-Assisted Thoracoscopic Surgery and Robotic Approaches for Clinical Stage I and Stage II Non-Small Cell Lung Cancer Using The Society of Thoracic Surgeons Database

Abstract

Background Data from selected centers show that robotic lobectomy (RL) is safe, effective and has comparable 30-day mortality to video assisted lobectomy (VATS). However, widespread adoption of RL is controversial. We used the STS-GTS-Database to evaluate quality metrics for these two minimally invasive lobectomy techniques. Methods A database query for primary clinical stage I or II NSCLC at high volume centers from 2009 to 2013 identified 1,220 RLs and 12,378 VATS. Quality metrics evaluated included operative morbidity, 30-day mortality and nodal upstaging (NU), defined as cN0 to pN1. Multivariable logistic regression was used to evaluate NU. Results RL patients were older, less active, less likely to be an ever smoker, and had higher BMI (all p<0.05). They were also more likely to have coronary heart disease or hypertension (all p<0.001) and to have had preoperative mediastinal staging (p<0.0001). RL operative times were longer (median 186 vs 173 min, p<0.001); all other operative parameters were similar. All postoperative outcomes were similar including complications and 30-day mortality (RL 0.6% vs VATS 0.8%, p=0.4). Median length of stay was 4 days for both, but a higher proportion of RLs stayed < 4 days: 48% vs 39%, p<0.001. NU overall was similar (p=0.6), but with trends favoring VATS in the cT1b group, and RL in the cT2a group. Conclusions RL patients had more co-morbidities and RL operative times were longer, but quality outcome measures including complications, hospital stay, 30-day mortality, and NU suggest RL and VATS are equivalent.

Robotic assisted lung resection needs further evidence

“…(9) have shown that although RATS operative times were longer (median 186 vs. 173 min), all postoperative outcomes were similar, including complications and 30-day mortality (robotic lobectomy, 0.6% vs. VATS, 0.8%; P=0.4). Median length of stay was 4 days for both, but a higher proportion of patients undergoing robotic lobectomy had hospital stays less than 4 days (48% vs. 39%; P<0.001).…”

Robotic lung cancer surgery: review of experience and costs

“…After a slow start, use of a robot to perform lobectomy and other pulmonary excisions has increased rapidly from 2009. According to a study on non-academic hospitals in the United States, based on the database of the Agency for Health Care Research and Quality, in 2009, 66% of lobectomies were performed by thoracotomy, 33% by video-assisted thoracoscopic surgery (VATS), and only 1% by robot-assisted surgery, while by 2013, robotic resections had risen to 11% of the total (3). An analysis of the US Nationwide Inpatient Sample database (4) found a rapid increase in the number robotic lobectomies performed between 2008 and 2011, and also of the number of centers offering robotic lung surgery.…”

Transition from video-assisted thoracic surgery to robotic pulmonary surgery

“…In 2014 Paul et al (14) reported that in comparison to VATS, robotic surgery had a higher rate of intraoperative injury and bleeding (robot 5.0% vs. VATS 2.0%) at a higher cost. In their 2016 analysis of the STS database, Louie et al (15) reported that in stage-I and stage-II cases a robotic lobectomy had more comorbidity and operative times were longer. In 2016, Cerfolio et al (16) reported that vascular complications occurred in 15 out of 632 robotic surgery cases (2.4%) and concluded that it was possible to safely manage blood-vessel injury during robotic surgery.…”