Ann Thorac Surg 2019 Apr 17. Epub 2019 Apr 17.
Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address:
Background: It is unclear whether the enhanced dexterity and visualization of the surgical robot lessens morbidity and influences staging or survival. We compared outcomes of robotic-assisted lobectomy (RAL) with thoracoscopic (VAL) or open lobectomy (OL) of non-small cell lung cancer (NSCLC).
Methods: Using a prospective surgical database, perioperative and cancer related outcomes of patients who received a lobectomy for NSCLC from 2011-2017 were analyzed. Outcomes between each surgical approach were compared using inverse probability of treatment weighting (IPTW) generated from the inverse of the propensity score.
Results: There were 831 patients: 106 RAL, 301 VAL, and 424 OL. More RAL patients than VAL received neoadjuvant therapy (16% vs 6%, p=0.001), but less than OL (28% vs 16%, p=0.014). After adjustment, RAL was associated with longer operative times, less blood loss, and improved nodal harvest (all p<0.02). There were no differences in morbidity, nodal upstaging, or mortality between surgical approaches. Length of stay was shorter with RAL vs OL (p<0.01). Unadjusted cost was higher after RAL vs VAL (p=0.003), but after adjustment cost differences disappeared.
Conclusions: RAL was associated with improved nodal harvest and less blood loss as compared with VAL or OL. Length of stay was shorter with RAL as opposed to OL. Unexpectedly, cost was not higher with RAL. The profile of those who received RAL more closely approximated OL, suggesting RAL may allow typical thoracotomy patients to receive minimally invasive surgery following adequate training and experience.