Comparison Of Robotic-assisted Versus Video-assisted Thoracoscopic Segmentectomy: A Single Institution Propensity Matched Study
Kojo Agyabeng-Dadzie1, Inderpal S. Sarkaria1, Ernest Chan1, Ian Christie1, Summer Mazur1, Kristine Ruppert2, Neil Christie1, Omar Awais1, Ryan Levy1, Nicholas Baker1, Rajeev Dhupar1, Arjun Pennathur1, James D. Luketich1, Matthew Schuchert1.
1University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 2University of Pittsburgh, Pittsburgh, PA, USA.
BACKGROUND: Previous studies have evaluated the feasibility of robotic-assisted thoracoscopic segmentectomy (RVATS) in comparison to video-assisted thoracoscopic segmentectomy (VATS). We report both short- and long-term outcomes comparing robotic-assisted and video-assisted segmentectomy at a single institution. METHODS: This is a retrospective propensity matched cohort study reviewing robotic-assisted and video-assisted segmentectomy for primary non-small cell lung cancer performed from 2013 to 2021 at our institution. 1:2 propensity matching of patient’s age, gender, smoking status, pulmonary function, comorbidities, and clinical stage was performed. RESULTS: There were 108 patients that underwent RVATS and 370 that underwent VATS for primary lung cancer. After propensity matching, we had two well matched cohorts of 102 patients in the RVATS group and 204 in the VATS group. Our data showed no significant difference in 90-day mortality (0 [0%] vs 3 [1.5%]; p=0.55), 30-day hospital readmission rate (11 [10.8%] vs 14 [6.9%]; p=0.25), or median number of lymph nodes (13 [IQR, 9-18] vs 12 [IQR, 7-16.5]; p=0.15), between our RVATS and VATS groups respectively. There was also no significant difference in post-operative morbidity except for pleural effusion (12 [11.8%] vs 8 [3.9%]; p=0.01) (Table 1). RVATS had significantly greater median number of lymph node stations harvested (5 [IQR, 4-6] vs 4 [IQR, 3-5]; p=0.04), and longer operative time (252.5 mins [IQR, 206-296mins] vs 186.5mins [IQR, 148-263mins]; p<0.0001). Although both groups achieved R0 resections in all patients, RVATS showed greater negative tumor margin distance compared to VATS (27mm [IQR, 20-40mm] vs 20mm [IQR, 11-30mm]; p<0.0001). There was a trend towards shorter hospital length of stay for the RVATS group (4 days [IQR, 3-5 days] vs 4 days [IQR, 3-6 days]; p=0.07). There was no significant difference in disease free survival (mean survival of 2.7 years [RVATS] vs 2.5 years [VATS]; p=0.40), as well as overall survival (mean survival of 2.5 years [RVATS] vs 2.8 years [VATS]; p=0.11) between the two groups at 3 years. CONCLUSIONS: In our experience, RVATS showed greater number of lymph node stations harvested, greater negative tumor margin distance, and a trend towards shorter hospital length of stay when compared to VATS, without compromising peri-operative and oncological outcomes for segmentectomy performed for non-small cell lung cancer. 
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