A Comparison of Total Thoracoscopic and Robotic Surgery for Lung Cancer Lymphadenectomy

SIMPLE SUMMARY: Some studies have demonstrated an association between systematic lymph node dissection (LND) and more accurate disease staging compared with dissection of randomly selected lymph nodes. The aim of this study was to retrospectively compare the quality and safety of LND performed via multiport robotic-assisted thoracic surgery (RATS) versus multiport thoracoscopy (TT). A total of 246 patients were included, 85 underwent lung resection via TT, and 161 underwent lung resection via RATS. LND was assessed based on the number of lymph node stations and the number of lymph nodes removed per station, and the postoperative complications were assessed for each technique. Some authors assert that RATS allows them to perform more extensive lymph node dissection, with a higher rate of node upstaging. This comparative study could be used to help evaluate the role of the robot in the technique. ABSTRACT: Background: Robotic-assisted thoracic surgery (RATS) is used increasingly frequently in major lung resection for early stage non-small-cell lung cancer (NSCLC) but has not yet been fully evaluated. The aim of this study was to compare the surgical outcomes of lymph node dissection (LND) performed via RATS with those from totally thoracoscopic (TT) four-port videothoracoscopy. Methods: Clinical and pathological data were collected retrospectively from patients with clinical stage N0 NSCLC who underwent pulmonary resection in the form of lobectomy or segmental resection between June 2010 and November 2022. The assessment criteria were number of mediastinal lymph nodes and number of mediastinal stations dissected via the RATS approach compared with the four-port TT approach. Results: A total of 246 pulmonary resections with LND for clinical stages I–II NSCLC were performed: 85 via TT and 161 via RATS. The clinical characteristics of the patients were similar in both groups. The number of mediastinal nodes dissected and mediastinal stations dissected was significantly higher in the RATS group (TT: mean ± SD, 10.72 ± 3.7; RATS, 14.74 ± 6.3 [p < 0.001]), except in the inferior mediastinal stations. There was no difference in terms of postoperative complications. Conclusions: In patients with early stage NSCLC undergoing major lung resection, the quality of hilomediastinal LND performed using RATS was superior to that performed using TT.