Comparative short-term outcomes of robotic-assisted vs video-assisted thoracic surgery in lung cancer: a multicenter retrospective study from EPITHOR with a quality audit

Abstract

Advancements in diagnostic imaging and surgical techniques have significantly evolved the treatment landscape of non-small cell lung cancer (NSCLC). The shift toward parenchymal-sparing approaches, such as segmentectomy for cT1a-bN0 tumors, is challenging the traditional lobectomy. This retrospective multicenter cohort study evaluates short-term outcomes of Video-Assisted Thoracoscopic Surgery (VATS) and Robotic-Assisted Thoracic Surgery (RATS) in NSCLC patients using data from the French EPITHOR registry, enhanced by an in-depth quality audit. The audit ensured the completeness and accuracy of the data by monitoring and improving the quality of data entry at participating centers. We included patients who underwent mini-invasive lobectomy or segmentectomy between January 2016 and December 2020. The primary outcome was the length of hospital stay (LOS), with secondary outcomes including complications, 90-day rehospitalization, and mortality. A total of 5687 interventions were analyzed, including 3692 VATS and 1995 RATS procedures. The unadjusted mean LOS was slightly shorter for RATS (7.61 days) compared to VATS (8.04 days), though this difference was not statistically significant after adjustment (p = 0.073). No significant differences were found in secondary outcomes, including complication rates and 90-day mortality. The integration of a comprehensive quality audit allowed for a robust comparison of outcomes, ensuring reliable and accurate data across all centers. While RATS showed a trend toward shorter hospital stays, this study did not find statistically significant differences in short-term outcomes between RATS and VATS after adjusting for confounders. Both RATS and VATS are viable options for lung resections, with the choice potentially guided by surgeon expertise and institutional resources.