Advantages of robotic-assisted thoracic surgery after neoadjuvant therapy in NSCLC: A propensity score-matched analysis.

BACKGROUND: Robot-assisted thoracic surgery (RATS) was advantageous in complex procedures. Neoadjuvant therapy leads to intra-operative difficulty in non-small cell lung cancer (NSCLC). The aim of this study was to compare RATS and video-assisted thoracic surgery (VATS) in neoadjuvant setting.

METHODS: This retrospective study included stage II-IIIB(N2) NSCLC patients who underwent surgery after receiving neoadjuvant therapy. Patients were grouped by RATS or VATS. The primary outcomes are R0 resection rate, operation time and estimated blood loss. The secondary outcome is the rate of conversion to thoracotomy. Demographic data, clinical data and pathological data were collected for analysis. Propensity score matching (PSM) was applied to balance bias.

RESULTS: Between July 2021 and June 2024, 118 patients received RATS and 317 patients received VATS were included. Before PSM, RATS was associated with a significantly shorter operative time (194 min vs. 223 min, p < 0.001) and a lower conversion rate to thoracotomy (8.47 % vs. 18.6 %, p = 0.015). However, no significant differences were observed in the R0 resection rate (p = 0.306) or mean estimated blood loss (p = 0.371). After PSM, RATS still demonstrated advantages in operation time (194 min vs 223 min, p = 0.001), reducing conversion caused by fibrosis or difficult exposure (p = 0.005), and number of N2 lymph nodes (p = 0.02). Single and multiple regressions both suggested RATS was associated with shorter operation time and lower conversion rate.

CONCLUSIONS: Our study suggested that RATS is a superior approach compared with VATS in neoadjuvant context, with advantages in shortening operation time, reducing conversion rate, and lymph node dissection.