Comparison of robot-assisted and video-assisted thoracic sleeve lobectomy in non-small cell lung cancer: insights from a high-volume center.

BACKGROUND

Although minimally invasive sleeve lobectomy (SL) preserves lung function, it is a complex and demanding thoracic surgical technique. This study aimed to evaluate perioperative and long-term outcomes of robot-assisted thoracic surgery (RATS) versus video-assisted thoracic surgery (VATS) in patients with non-small cell lung cancer (NSCLC) undergoing SL, and explore the safety and feasibility of robot-assisted SL in patients following neoadjuvant therapy.

METHODS

A retrospective analysis was performed on a cohort of patients diagnosed with NSCLC who underwent minimally invasive SL at a high-volume center between December 2019 and February 2023. Demographic characteristics, perioperative outcomes, and survival rates were compared between the RATS and VATS groups.

RESULTS

The study enrolled 347 patients with NSCLC, 78 (22.5%) patients received RATS and 269 (77.5%) patients received VATS. In the overall cohort, the RATS group was associated with a greater number of dissected lymph nodes (18.0 vs. 16.0; P=0.048) and a lower conversion rate (6.4% vs. 18.2%; P=0.01) than the VATS group. The overall median follow-up for the entire cohort was 34 [interquartile range (IQR), 26-42] months, with 30 (IQR, 26-38) months in the RATS group and 35 (IQR, 25-44) months in the VATS group. The Kaplan-Meier survival curves showed no significant difference in overall survival and progression-free survival (P=0.68 and P=0.98, respectively) between the groups.

CONCLUSIONS

Robot-assisted SL shows comparable results to VATS group for perioperative and long-term tumor prognosis. For patients who have received neoadjuvant therapy, robot-assisted SL is a safe and feasible option.