Robotic-assisted thoracic surgery reduces perioperative complications and achieves a similar long-term survival profile as posterolateral thoracotomy in clinical N2 stage non-small cell lung cancer patients: a multicenter, randomized, controlled trial

Abstract

Background: Our previous study demonstrated the safety and short-term efficacy of robotic-assisted thoracic surgery (RATS) in clinical N2 (c-N2) stage non-small cell lung cancer (NSCLC) patients. From this, the present study was devised, in which the follow-up time and sample size were both extended to explore the long-term efficacy and potential benefit in survival of RATS compared with lobectomy in c-N2 stage NSCLC patients.Methods: Patients with c-N2 NSCLS were randomly assigned in a 1:1 ratio to accept operation through thoracotomy or RATS. The da Vinci Surgical System (Si/Xi) was applied in the RATS group, while conventional lobectomy with a rib-spreading incision was applied in the posterolateral thoracotomy group.Primary endpoint was defined as disease free survival and overall survival (OS) of all recruited patients.Results: Compared with posterolateral thoracotomy group (N=72), the RATS group (N=76) had a reduced blood loss (P<0.001), decreased drainage duration (P=0.002), and decreased postoperative pain visual analog score (all P<0.001), but increased overall cost (P<0.001). Meanwhile, no difference in the other postoperative complications (such as air leakage, subcutaneous emphysema, atrial fibrillation etc.) was found between the RATS group and the posterolateral thoracotomy group (all P>0.05). Regarding long-term outcome, no difference in disease-free survival (DFS; P=0.925) or OS (P=0.853) was observed between the RATS group and posterolateral thoracotomy group. Subgroup analyses and multivariable Cox regression analyses also found no difference in DFS or OS between the RATS group and posterolateral thoracotomy groups.Conclusions: RATS reduced intraoperative bleeding, drainage duration, postoperative pain, and achieved similar long-term survival outcomes compared with posterolateral thoracotomy in c-N2 stage NSCLC patients.

Robot-assisted vs. video-assisted thoracoscopic surgery in lung cancer

“…we did not observe any difference in the duration of epidural tube use. Although many studies reported that RATS showed a more favorable pain control profile compared with thoracotomy, there were no significant difference between RATS and VATS (21,22).…”

Comparison of the perioperative outcomes between robotic-assisted thoracic surgery and video-assisted thoracic surgery in non-small cell lung cancer patients with different body mass index ranges

“…The best surgical option for resectable stage II and above NSCLC is still controversial, and studies generally agree that thoracotomy can achieve excellent long-term postoperative outcomes, especially in lymph node dissection (13,19). It has been reported recently that RATS has the same long-term outcomes as thoracotomy and VATS, as well as better short-term results (20)(21)(22)(23)(24). The ROMAN study (7) and RVlob Trial (25), which is a perioperative randomized multicentric clinical trial for stage I-II NSCLC, both confirmed that robotic methods can improve lymph node staging and obtain a higher lymph node yield.…”

Complications of Robotic Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy for Resectable Non-Small Cell Lung Cancer

“…Following review of the title and abstract, 863 studies were excluded and a full text review was performed on the remaining 47 articles. Twenty-two studies reporting on a total of 104,472 patients who underwent either RVATS ( n = 12,061) or open thoracotomy ( n = 92,411) lung resection met the selection criteria [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. A summary of the study selection process is shown in Figure 1 as a PRISMA flowchart.…”

“…A more recent network meta-analysis of 34 studies of 183,426 patients by Aiolfi [ 3 ] showed significantly reduced 30-day mortality, pulmonary and overall complications, as well as equivocal oncological and five-year survival outcomes in RVATS compared to VATS and open thoracotomy. However, a multicenter randomized controlled trial by Huang [ 11 ], comparing RVATS with open thoracotomy in 148 patients with N2 NSCLC, reported only significant reductions in blood loss, pain and chest drain duration in the RVATS group, but no difference in the other postoperative outcomes. In contrast to the previous studies, this present meta-analysis has shown a significant reduction in atrial arrhythmia and a significant increase in the number of lymph nodes stations harvested in the RVATS group compared to open thoracotomy.…”

“… Atrial arrythmia in patients who underwent robotic video-assisted thoracoscopic surgery compared with open thoracotomy for resectable non-small cell lung cancer [ 7 , 8 , 9 , 11 , 12 , 13 , 14 , 17 , 18 , 19 , 21 , 23 , 26 ]. …”