Outcomes of robotic vs video-assisted thoracoscopic segmentectomy in early-stage NSCLC: A meta-analysis of propensity-matched studies.

INTRODUCTION

Robotic-assisted thoracoscopic segmentectomy (RATS) has been increasingly adopted for early-stage non-small cell lung cancer (NSCLC), yet comparative effectiveness versus video-assisted thoracoscopic segmentectomy (VATS) remains uncertain. We performed a meta-analysis restricted to propensity-matched studies to compare perioperative and oncologic outcomes between approaches.

METHODS

A comprehensive literature search was conducted to identify studies comparing RATS and VATS. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Overall survival (OS) was reconstructed from published Kaplan-Meier curves and analyzed using Cox proportional hazards models.

RESULTS

Five studies comprising 14,007 patients with 3,233 (23.1%) undergoing RATS were included. RATS was associated with lower intraoperative blood loss (MD -8.82, 95% CI -16.37 to -1.28, p = 0.02). Median overall survival was similar between groups at 4.6 years for both RATS and VATS (HR 0.98, 95% CI 0.90 to 1.08, p = 0.72). Operative time, cost, nodal assessment, chest drainage duration, hospital length of stay, conversion to thoracotomy, 30-day readmission, persistent air leak, atrial arrhythmia, and 90-day mortality were comparable.

CONCLUSIONS

Both surgical approaches provide comparable perioperative safety and oncologic adequacy. Procedure selection should be individualized, taking into account surgeon expertise, case complexity, resource availability, and cost considerations.