Pain and recovery after robotic vs. uniportal lobectomy for lung cancer: a comparative analysis

Abstract

BACKGROUND: Minimally invasive thoracic surgery techniques, such as robotic-assisted thoracic surgery (RATS) and uniportal video-assisted thoracoscopic surgery (UVATS), have revolutionized lung cancer treatment. However, comparative data on postoperative pain and functional recovery remain limited. This cohort study evaluates differences in pain intensity and pain-related activity limitations following radical lobectomy for lung cancer. METHODS: A total of 140 patients undergoing lobectomy (70 RATS, 70 UVATS) were prospectively assessed. Pain intensity was measured using the Visual Analog Scale (VAS), and functional impact was evaluated with the Daily Activity Pain Interference Questionnaire (DAPIQ) on postoperative days 3 and 14. Demographic factors, including sex and body mass index (BMI), were analyzed as potential modifiers. RESULTS: Patients in the RATS group reported significantly higher VAS scores compared to the UVATS group on postoperative day 3 (5.8 ± 2.0 vs. 3.8 ± 1.6; p < 0.001) and day 14 (2.7 ± 1.1 vs. 2.2 ± 1.1; p = 0.001). Only 17.1% of RATS patients were pain-free by day 14, compared to 34.3% in the UVATS group (p = 0.016). The likelihood of pain-related activity interference was 3.8 times higher in the RATS group. Female sex and lower BMI were associated with worse pain outcomes. VAS scores strongly correlated with DAPIQ results (β = 0.43). CONCLUSIONS: This study demonstrates that RATS is associated with significantly greater postoperative pain and functional limitations than UVATS following lobectomy for lung cancer. These findings underscore the importance of tailored pain management strategies in robotic thoracic surgery, particularly for higher-risk subgroups. Integration of the DAPIQ questionnaire into routine postoperative care may enhance functional recovery monitoring.