Comparison of robotic and video-assisted thoracic surgery for lung cancer: a propensity-matched analysis

Background: Reports of comparison between robotic and thoracoscopic surgery for lung cancer are limited, we aimed to compare the perioperative outcomes of robotic and thoracoscopic anatomic pulmonary resection for lung cancer. Methods: A total of 184 patients with lung cancer underwent anatomic pulmonary resection by robotics or thoracoscopy. A propensity-matched analysis with incorporated preoperative variables was used to compare the perioperative outcomes between the two procedures. Results: Overall, 71 patients underwent robotic pulmonary resection, including 64 lobectomies and 7 segmentectomies, while 113 patients underwent thoracoscopic lobectomy and segmentectomy. Propensity match produced 69 pairs. The mean length of postoperative stay (7.6 +/- 4.6 vs. 6.4 +/- 2.6 d, P=0.078), chest tube duration (5.3 +/- 3.7 vs. 4.4 +/- 1.7 d, P=0.056), number of lymph nodes retrieved (17.9 +/- 6.9 vs. 17.4 +/- 7.0, P=0.660), stations of lymph nodes resected (7.4 +/- 1.6 vs. 7.6 +/- 1.7, P=0.563), operative blood loss (53.9 +/- 29.3 vs. 50.3 +/- 37.9 mL, P=0.531), morbidity rates (42.0% vs. 30.4%, P=0.157) were similar between the robotics and thoracoscopy. However, robotics was associated with higher cost ($12,067 +/- 1,610 vs. $8,328 +/- 1,004, P<0.001), and longer operative time (136 +/- 40 vs. 111 +/- 28 min, P<0.001). Conclusions: Robotics seems to have higher hospital costs and longer operative time, without superior advantages in morbidity rates and oncologic efficiency. Further prospective randomized clinical trials were needed to validate both of its short-and long-term oncologic efficiency.