Robotic-assisted versus video-assisted thoracoscopic anatomical pulmonary resection in elderly patients with lung cancer: A propensity score-matched comparison of short-term outcomes.

OBJECTIVE

Lung cancer is a major health issue, particularly among the elderly. This study aimed to compare the short-term outcomes of robot-assisted thoracoscopic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for anatomical pulmonary resection in elderly patients with lung cancer.

METHODS

A retrospective analysis was performed on patients aged ≥65 years who underwent RATS or VATS. Propensity score matching (PSM) was applied to balance baseline characteristics. Demographic, clinical, and perioperative variables were compared.

RESULTS

A total of 594 patients who underwent anatomical pulmonary resection for non-small cell lung cancer (NSCLC) were enrolled, with 141 patients received RATS and 453 received VATS, respectively. After matching, 117 pairs (234 patients) were created in this study, and baseline characteristics were well-balanced between groups. Compared to VATS, the RATS group had significantly shorter operative time (156 ± 51.67 vs. 214.3 ± 89.95 min, p < 0.001), lower intraoperative blood loss (44.96 ± 83.49 vs. 149.44 ± 461.51 mL, p = 0.017), shorter chest tube duration (5.93 ± 3.83 vs. 6.46 ± 4.9 days, p = 0.041), reduced total drainage volume (1149.36 ± 728.31 vs. 1501.92 ± 1662.32 mL, p = 0.037), shorter postoperative hospital stay (6.77 ± 3.46 vs. 9.66 ± 8.15 days, p = 0.001), and lower pain scores on postoperative day 3 (3.49 ± 1.46 vs. 4.09 ± 1.60, p = 0.003). The conversion rate to open surgery was lower in the RATS group (0.9% vs. 7.7%, p = 0.010). The total hospitalization costs were significant higher in RATS group (p = 0.002). No significant differences were observed in postoperative complications, lymph node dissection outcomes (p > 0.05).

CONCLUSION

Compared with VATS, RATS demonstrated favorable short-term clinical outcomes in elderly lung cancer patients, including shorter operative time, diminished blood loss, reduced drainage, shorter hospital stay, and alleviated early postoperative pain, alongside higher hospitalization costs, while maintaining comparable complication rates. RATS appears to be a safe and effective minimally invasive alternative for this population.