The treatment landscape for non-small cell lung cancer (NSCLC) has progressed significantly due to advancements in diagnostic imaging and surgical techniques. This evolution has shifted the focus toward parenchymal-sparing approaches, such as segmentectomy for small tumours (cT1a-bN0), challenging the traditional lobectomy, which has long been considered the gold standard.

Study Objective

This multicentre retrospective cohort study aimed to evaluate the short-term outcomes of Video-Assisted Thoracoscopic Surgery (VATS) and Robotic-Assisted Thoracic Surgery (RATS) in patients with non-small cell lung cancer. The study utilized data from the French EPITHOR registry, complemented by a comprehensive quality audit to improve the reliability of the findings.

Methods

The study included patients aged 18 and older who underwent elective mini-invasive lobectomy or segmentectomy for histologically confirmed non-small cell lung cancer between January 2016 and December 2020. A total of 5687 interventions were analysed, consisting of 3692 VATS and 1995 RATS procedures. The primary outcome measured was the length of hospital stay (LOS), while secondary outcomes included complication rates, 90-day rehospitalization, and mortality.

Results

The unadjusted mean LOS was slightly shorter for RATS (7.61 days) compared to VATS (8.04 days), but this difference was not statistically significant after adjustment (p = 0.073). Furthermore, there were no significant differences in secondary outcomes, including complication rates and 90-day mortality. The study demonstrated that both RATS and VATS are viable options for lung resections, with the choice potentially influenced by surgeon expertise and institutional resources.

Quality Audit Impact

The integration of a quality audit was pivotal as it ensured the completeness and accuracy of data across participating centres. This robust data quality allowed for a more reliable comparison of outcomes between the two surgical approaches.

Discussion

The findings of this study align with previous literature, which has shown mixed results regarding LOS when comparing RATS and VATS. While some studies report significant reductions in LOS favouring RATS, others find no significant differences. The observed trend toward shorter hospital stays with RATS could be attributed to the ongoing adoption of enhanced recovery protocols across French thoracic surgery centres, coupled with the lingering learning curve associated with RATS among some surgeons.

The study noted a slight increase in segmentectomy procedures over lobectomies from 2016 to 2020, reflecting a broader trend toward lung-sparing strategies for treating early-stage lung cancer. This shift is likely influenced by improved screening techniques and advancements in robotic surgical technology.

Limitations

Despite the strengths of the study, including the extensive quality audit, limitations exist. The retrospective nature of the study may introduce biases, particularly regarding data collection and the variability in surgical techniques. The learning curve associated with RATS also complicates the evaluation of its effectiveness compared to VATS.

Conclusion

In conclusion, while RATS showed a trend toward shorter hospital stays, the differences were not statistically significant after adjustment. No significant differences were found in complication rates, 90-day rehospitalization, or mortality between RATS and VATS. The study also highlighted an increasing trend in the use of segmentectomy, with robotic surgery emerging as a preferred method for performing such procedures due to its enhanced precision and dexterity.

This research underscores the importance of continued evaluation and adaptation of surgical techniques to improve patient outcomes in lung cancer surgery, advocating for greater access to robotic technologies in thoracic surgery.

READ MORE… https://link.springer.com/article/10.1007/s11701-024-02174-4

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