Original article
General thoracic
Comparison of Video-Assisted Thoracoscopic Surgery and Robotic Approaches for Clinical Stage I and Stage II Non-Small Cell Lung Cancer Using The Society of Thoracic Surgeons Database

Presented at the Fifty-second Annual Meeting of The Society of Thoracic Surgeons, Phoenix, AZ, Jan 23–27, 2016.
https://doi.org/10.1016/j.athoracsur.2016.03.032Get rights and content

Background

Data from selected centers show that robotic lobectomy is safe and effective and has 30-day mortality comparable to that of video-assisted thoracoscopic surgery (VATS). However, widespread adoption of robotic lobectomy is controversial. We used The Society of Thoracic Surgeons General Thoracic Surgery (STS-GTS) Database to evaluate quality metrics for these 2 minimally invasive lobectomy techniques.

Methods

A database query for primary clinical stage I or stage II non-small cell lung cancer (NSCLC) at high-volume centers from 2009 to 2013 identified 1,220 robotic lobectomies and 12,378 VATS procedures. Quality metrics evaluated included operative morbidity, 30-day mortality, and nodal upstaging, defined as cN0 to pN1. Multivariable logistic regression was used to evaluate nodal upstaging.

Results

Patients undergoing robotic lobectomy were older, less active, and less likely to be an ever smoker and had higher body mass index (BMI) (all p < 0.05). They were also more likely to have coronary heart disease or hypertension (all p < 0.001) and to have had preoperative mediastinal staging (p < 0.0001).

Robotic lobectomy operative times were longer (median 186 versus 173 minutes; p < 0.001); all other operative measurements were similar. All postoperative outcomes were similar, including complications and 30-day mortality (robotic lobectomy, 0.6% versus VATS, 0.8%; p = 0.4). Median length of stay was 4 days for both, but a higher proportion of patients undergoing robotic lobectomy had hospital stays less than 4 days (48% versus 39%; p < 0.001). Nodal upstaging overall was similar (p = 0.6) but with trends favoring VATS in the cT1b group and robotic lobectomy in the cT2a group.

Conclusions

Patients undergoing robotic lobectomy had more comorbidities and robotic lobectomy operative times were longer, but quality outcome measures, including complications, hospital stay, 30-day mortality, and nodal upstaging, suggest that robotic lobectomy and VATS are equivalent.

Section snippets

Patients

The STS-GTD (data versions 2.081 to 2.2 covering 2009–2013) was queried for primary lobectomy operations for lung cancer. Operations without a VATS or robotic designation (33,645) or operations that were coded with both VATS/open (n = 303) or robotic/open (n = 416) were assumed to be “conversions” and were excluded. VATS and robotic cases were excluded if the reporting center had not done at least 20 robotic or 20 VATS cases (75 centers with 1,656 cases). Patients with clinical stage I or stage

Results

From a total of 52,505 cases, 1,220 robotic lobectomies and 12,378 VATS lobectomies from 140 reporting centers were identified. The number of robotic lobectomies increased each year, and the number of centers reporting experience with robotic lobectomy also increased. In the final year, robotic lobectomy accounted for 14% of all minimally invasive lobectomies (Fig 1). Of the 128 centers contributing cases, 18 reported both VATS and robotic approaches and 4 reported only robotic cases. Four of

Comment

The primary finding in this analysis is that there are no significant differences in perioperative outcomes between robotic lobectomy and VATS lobectomy. We also found no difference in nodal upstaging between the 2 procedures. Overall, these results are similar to the single-institution comparative studies of robotic lobectomy versus VATS 14, 16, the multiinstitutional comparative studies against the STS-GTD 18, 22, other administrative database comparisons [17], and a recent meta-analysis [23].

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