Long-Term Outcomes of Robotic-Assisted, Video-Assisted and Open Surgery in Non-Small Cell Lung Cancer: A Matched Analysis

Abstract

Introduction: This study makes a comparison between stage I non-small cell lung cancer (NSCLC) patients subjected to either robotic-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS) or open thoracotomy, with the aim to evaluate differences between these three approaches in terms of oncological outcomes. Method: We reviewed data from 1367 consecutive patients who, between 2011 and 2017, underwent lobectomy for NSCLC with either open surgery, VATS or RATS, and performed a matched case-control study based on patients’ age, gender, clinical stage (IA, IB) and ASA score. Results: 180 patients (n = 72 RATS, n = 36 VATS, n = 72 open) were analyzed. Complication rates were found to be comparable (72.2% open, 86.1% VATS, 81.9% RATS), with similar grades of severity. The median number of resected lymph nodes was higher in open surgery (n = 22) than in VATS (n = 15; p = 0.0001) and in RATS (n = 17; p = 0.004). Pathological N2 upstaging was higher in open surgery (9.7%) compared to VATS (5.6%) and RATS (5.6%). However, the recurrence rate in VATS was significantly higher than in RATS (log rank p = 0.03). No statistically significant differences were detected in 5-year OS and cancer-specific survival. Conclusions: no differences were found in OS and cancer-specific survival between VATS, RATS and open lobectomy for stage I NSCLC patients; even if in VATS, the incidence of recurrences, in particular local recurrences, was higher than in RATS and in open surgery.

Vats lobectomy for lung cancer. What has been the evolution over the time?

“…However, a recent paper of Casiraghi et al. reported no differences in overall survival and cancer-specific survival between VATS, RATS and open lobectomy for stage I NSCLC patients; even if in VATS, the incidence of recurrences, in particular local recurrences, was higher than in RATS and in open surgery ( 51 ). Anyway, several limits remain typical of RATS if compared to VATS approach, such as the high costs, the availability in peripherical structures and longer learning curve in surgeons without solid mini-invasive background ( 52 ).…”

Learning Curve of Robotic Lobectomy for the Treatment of Lung Cancer: How Does It Impact on the Autonomic Nervous System of the Surgeon?

“…More specifically, the advantages of robotic surgery have been widely investigated in the recent past; nowadays, robotic lobectomy represents the gold standard in the treatment of early lung cancer, being feasible and safe, with clinical outcomes similar, or in some cases superior, to those of video-assisted thoracoscopic or open surgery [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ].…”

“…At present, robotic lobectomy is considered an achievable and safe procedure [ 2 , 3 , 4 , 5 ], with clinical and oncological outcomes comparable to those of video-assisted thoracoscopic surgery (VATS)/thoracotomy, both in early [ 6 , 7 , 8 , 9 ] and in advanced stages (II-IIIA NSCLC) with no differences in medium and long-term survival [ 10 ].…”

How Much Stress Does a Surgeon Endure? The Effects of the Robotic Approach on the Autonomic Nervous System of a Surgeon in the Modern Era of Thoracic Surgery

“…The advantages of minimally invasive and robotic surgery have been widely discussed in the literature, and at present, robotic lobectomy is recognized as being a feasible and safe approach [2][3][4][5], with clinical outcomes similar, or in some cases superior, to those of video-assisted thoracoscopic surgery (VATS) [6][7][8][9], even in advanced stages (II-IIIA NSCLC) [10].…”