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OBJECTIVE: Comparative studies of robotic lung surgery are limited. We compare perioperative and long-term outcomes of robotic and video-assisted thoracoscopic (VATS) lung resection. We address the limitation of previous studies by controlling for institution and surgeon expertise to minimize the confounding effects from surgeons’ experience on the observed benefits and risks.
METHODS: A retrospective analysis of consecutive anatomic lung resections using robot or VATS by a single surgeon experienced in both approaches was performed to compare perioperative characteristics and long-term survival.
RESULTS: From December 2010 to June 2015, 61 patients underwent robotic surgery, and 105 patients underwent VATS. Patient demographics were similar except that the VATS group had higher percentage of diabetic patients (Robotic 9/61 (14.75%) vs VATS 32/105 (30.48%), p=0.0258) and a slightly lower percentage of patients with previous cancer history (Robotic 35/61 (57.38%) vs VATS 43/105 (40.95%), p=0.0409). The robotic group had a higher rate of prolonged air leak ≥ 7 d (Robotic 9/61 (14.75%) vs VATS 4/105 (3.81%); p=0.0161), and a modestly longer length of hospital stay (Robotic median of 4.0 days vs. VATS median of 3.0 days, p=0.0123). Other postoperative complications, mortality, nodal upstaging and conversion rate were similar. Disease-free survival was not different. However, the robotic group enjoyed slightly better overall survival than the VATS group (log-rank test of Kaplan-Meier survival curve, p=0.0292).
CONCLUSIONS: Robotic anatomic lung resection appears to be associated with a higher rate of prolonged air leak (≥ 7 d), and resulting slightly longer length of hospital stay than VATS. Within the same follow-up period, disease-free survival was similar, while overall survival is slightly better in the robotic group.