Frontiers in oncology · 2026
Perioperative outcomes of robot-assisted versus video-assisted thoracoscopic surgery for non-small cell lung cancer: a meta-analysis focusing on real-world clinical studies in the past 10 years.
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Zhu Jianfang, Meng Xiaopeng, Hu Liyong
Аннотация
OBJECTIVE: Non-small cell lung cancer (NSCLC) accounts for more than 80% of lung cancer cases, and minimally invasive lobectomy is a standard curative approach for early-stage disease. The comparative perioperative outcomes of Robot-assisted thoracoscopic surgery (RATS) and Video-assisted thoracoscopic surgery (VATS) remain controversial. This meta-analysis compared perioperative outcomes of RATS and VATS for NSCLC using real-world clinical studies while excluding database-based analyses to better reflect routine practice.
METHODS: PubMed, Embase, the Cochrane Library, and Web of Science were searched for English-language studies published from January 2016 to December 2025. Eligible studies were real-world clinical reports directly comparing RATS with VATS in NSCLC; database analyses and clinical trials were excluded. Two reviewers independently screened studies and extracted data. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed with Review Manager 5.3.
RESULTS: Nine studies were included (7 high-quality and 2 moderate-quality), involving 2, 130 patients with NSCLC (RATS: 1, 090; VATS: 1, 040). Pooled analyses showed no significant differences between RATS and VATS in intraoperative blood loss, postoperative length of stay, or postoperative complication rates. RATS was associated with a higher lymph node yield than VATS (weighted mean difference, +2.38). In the lobectomy subgroup, operative time and postoperative length of stay were shorter with RATS. Funnel plots did not suggest substantial publication bias.
CONCLUSION: Based on real-world clinical evidence, RATS and VATS achieve comparable perioperative safety and short-term outcomes in NSCLC. RATS is associated with greater lymph node retrieval and may be a reasonable option when nodal yield is prioritized, particularly for patients undergoing lobectomy.
METHODS: PubMed, Embase, the Cochrane Library, and Web of Science were searched for English-language studies published from January 2016 to December 2025. Eligible studies were real-world clinical reports directly comparing RATS with VATS in NSCLC; database analyses and clinical trials were excluded. Two reviewers independently screened studies and extracted data. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed with Review Manager 5.3.
RESULTS: Nine studies were included (7 high-quality and 2 moderate-quality), involving 2, 130 patients with NSCLC (RATS: 1, 090; VATS: 1, 040). Pooled analyses showed no significant differences between RATS and VATS in intraoperative blood loss, postoperative length of stay, or postoperative complication rates. RATS was associated with a higher lymph node yield than VATS (weighted mean difference, +2.38). In the lobectomy subgroup, operative time and postoperative length of stay were shorter with RATS. Funnel plots did not suggest substantial publication bias.
CONCLUSION: Based on real-world clinical evidence, RATS and VATS achieve comparable perioperative safety and short-term outcomes in NSCLC. RATS is associated with greater lymph node retrieval and may be a reasonable option when nodal yield is prioritized, particularly for patients undergoing lobectomy.