Lymph Node Upstaging in Robotic, Video-Assisted Thoracic Surgery, and Open Lung Resections: A Matched Analysis From the Brazilian Lung Cancer Registry.

OBJECTIVES

To evaluate if the use of robotic technique (RATS) was able to achieve a better lymph node staging when compared with video-assisted (VATS) and open techniques for lung resections for treatment of non-small cell lung cancer.

METHODS

We used data from the Brazilian Lung Cancer Registry to retrospectively analyse 1376 patients submitted to lung resections for non-small cell lung cancer with curative intention. A propensity score matching analysis was performed to create groups with comparable baseline characteristics in a pairwise fashion (open vs RATS and VATS vs RATS). The primary endpoint was nodal upstaging.

RESULTS

After propensity score matching, 165 patients in the open group were compared with 165 in the RATS group. The rate of overall upstaging was higher in the open but not statistically significant when compared with RATS (open 22.4% vs RATS 15.2%; P = .09). Total lymph node count was similar for both groups (open 10; interquartile range [IQR] 5-17 vs RATS 11; IQR 8-17), P = .054). In the other comparison, 279 patients in the VATS group were compared with 279 patients in the RATS group. The rate of overall upstaging was the same in both groups (VATS 11.1% vs RATS 11.1%; P = 1). RATS had a higher number of lymph nodes harvested (VATS 9; IQR 6-13 vs RATS 10; IQR 7-15, P < .001).

CONCLUSIONS

RATS had a similar upstaging rate when compared with both VATS and open techniques.