Subcostal single-port versus intercostal multi-port robotic lobectomy for non-small cell lung cancer: a retrospective propensity score-matched cohort study

Abstract

BACKGROUND: To compare the perioperative and mid-term outcomes of robotic lobectomy using the single-port (SP) system via the subcostal approach with those of multi-port (MP) robotic lobectomy using the Xi system via the intercostal approach. MATERIALS AND METHODS: We reviewed patients who underwent robotic lobectomy for non-small cell lung cancer between January 2017 and December 2024. The patients were divided into the SP and MP groups based on the surgical approach, and their perioperative and mid-term outcomes were analyzed. RESULTS: In total, 339 patients were included in this study, and 112 patients were included in each group after propensity score matching. The SP group showed significantly shorter total operative (175 min vs. 193.5 min; p = 0.002) and console times (144 min vs. 167 min; p < 0.001), reduced chest tube drainage (667.5 mL vs. 842.5 mL; p = 0.036), and lower postoperative pain scores on postoperative days 0, 1, 2, and 3 (p < 0.05) than the MP group. Additionally, the SP group had significantly higher actual/predicted postoperative forced expiratory volume in 1 second ratios at 1, 3, and 6 months than the MP group (p < 0.05). The 3-year recurrence free survival rate was 88.3% (95% CI, 81.3-95.9) in the SP group and 81.1% (95% CI, 74.0-88.9) in the MP group (log-rank p = 0.449). CONCLUSIONS: Robotic lobectomy using the SP system showed favorable perioperative outcomes and mid-term results comparable to those of the MP group. However, further large-scale studies are required to validate our findings.