Comparison of medium-term survival outcomes between robot-assisted thoracoscopic surgery and video-assisted thoracoscopic surgery in treating primary lung cancer

• Published in: General thoracic and cardiovascular surgery Vol. 68; no. 9; pp. 984 - 992
• Main Authors: Haruki, Tomohiro, Kubouchi, Yasuaki, Takagi, Yuzo, Kidokoro, Yoshiteru, Matsui, Shinji, Nakanishi, Atsuyuki, Miwa, Ken, Taniguchi, Yuji, Nakamura, Hiroshige
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.09.2020; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Body mass index; Cardiac Surgery; Cardiology; Chi-square test; Classification; Endoscopy; Female; Follow-Up Studies; Humans; Japan - epidemiology; Lung cancer; Lung Neoplasms - mortality; Lung Neoplasms - surgery; Lymphatic system; Male; Medicine; Medicine & Public Health; Middle Aged; National health insurance; Operative Time; Original Article; Ostomy; Patients; Pneumonectomy - methods; Postoperative Period; Prognosis; Propensity Score; Robotics; Robotics - instrumentation; Surgical Oncology; Surgical outcomes; Survival Rate - trends; Thoracic Surgery; Thoracic Surgery, Video-Assisted - methods; Time Factors; Tomography; Tumors; Japan; United States > US; Propensity score matching; Video-assisted thoracoscopic surgery; Robot-assisted thoracoscopic surgery; Survival; Lung cancer
• DOI: 10.1007/s11748-020-01312-7
• ISSN: 1863-6705

Objectives Robot-assisted thoracoscopic surgery (RATS) for primary lung cancer has been spreading rapidly in Japan. While RATS has various technical advantages over video-assisted thoracoscopic surgery (VATS), the quality of surgery from an oncologic viewpoint must be maintained, and the evaluation of medium- to long-term survival outcomes is momentous. Methods This study included 299 patients with primary lung cancer (VATS, n  = 246; RATS, n  = 53) who underwent lobectomy and mediastinal lymph node dissection at our hospital. We reviewed and compared perioperative factors, the number of dissected lymph nodes, and postoperative recurrence between the VATS and RATS groups. We also compared the postoperative survival rates among 98 patients (49 patients in each group) whose background factors were adjusted by propensity score matching (PSM). Results After PSM, a significant difference was found in the total operative time between the two groups ( p  < 0.01); however, no difference was found between the RATS console time and VATS total operative time ( p  = 0.68). Postoperative recurrence was not significantly different between the groups (VATS, 14%; RATS, 6%; p  = 0.18). The 3-year recurrence-free survival rate was not significantly different between the groups (VATS, 91.7%; RATS, 91.2%; p  = 0.21). Conclusions RATS had promising survival results, which were similar to those of VATS even after PSM. Further case series and longer observation periods are needed to determine what technical benefits of RATS may affect the prognosis of lung cancer.