Robotic-assisted thoracic surgery reduces perioperative complications and achieves a similar long-term survival profile as posterolateral thoracotomy in clinical N2 stage non-small cell lung cancer patients: a multicenter, randomized, controlled trial

Jia Huang; Yu Tian; Chongwu Li; Yaofeng Shen; Hecheng Li; Fanzhen Lv; Hao Lin; Peiji Lu; Jules Lin; Christopher Lau; Ricardo Mingarini Terra; Long Jiang; Qingquan Luo

doi:10.21037/tlcr-21-898

Robotic-assisted thoracic surgery reduces perioperative complications and achieves a similar long-term survival profile as posterolateral thoracotomy in clinical N2 stage non-small cell lung cancer patients: a multicenter, randomized, controlled trial

Transl Lung Cancer Res. 2021 Nov;10(11):4281-4292. doi: 10.21037/tlcr-21-898.

Authors

Jia Huang^#¹, Yu Tian^#¹, Chongwu Li^#², Yaofeng Shen^#³, Hecheng Li⁴, Fanzhen Lv⁵, Hao Lin¹, Peiji Lu¹, Jules Lin⁶, Christopher Lau⁷, Ricardo Mingarini Terra⁸, Long Jiang¹, Qingquan Luo¹

Affiliations

¹ Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
² Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
³ Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
⁴ Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁵ Department of Thoracic Surgery, The Affiliated Huadong Hospital of Fudan University, Shanghai, China.
⁶ Department of Surgery, Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA.
⁷ Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
⁸ Thoracic Surgery Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.

^# Contributed equally.

Abstract

Background: Our previous study demonstrated the safety and short-term efficacy of robotic-assisted thoracic surgery (RATS) in clinical N2 (c-N2) stage non-small cell lung cancer (NSCLC) patients. From this, the present study was devised, in which the follow-up time and sample size were both extended to explore the long-term efficacy and potential benefit in survival of RATS compared with lobectomy in c-N2 stage NSCLC patients.

Methods: Patients with c-N2 NSCLS were randomly assigned in a 1:1 ratio to accept operation through thoracotomy or RATS. The da Vinci Surgical System (Si/Xi) was applied in the RATS group, while conventional lobectomy with a rib-spreading incision was applied in the posterolateral thoracotomy group. Primary endpoint was defined as disease free survival and overall survival (OS) of all recruited patients.

Results: Compared with posterolateral thoracotomy group (N=72), the RATS group (N=76) had a reduced blood loss (P<0.001), decreased drainage duration (P=0.002), and decreased postoperative pain visual analog score (all P<0.001), but increased overall cost (P<0.001). Meanwhile, no difference in the other postoperative complications (such as air leakage, subcutaneous emphysema, atrial fibrillation etc.) was found between the RATS group and the posterolateral thoracotomy group (all P>0.05). Regarding long-term outcome, no difference in disease-free survival (DFS; P=0.925) or OS (P=0.853) was observed between the RATS group and posterolateral thoracotomy group. Subgroup analyses and multivariable Cox regression analyses also found no difference in DFS or OS between the RATS group and posterolateral thoracotomy groups.

Conclusions: RATS reduced intraoperative bleeding, drainage duration, postoperative pain, and achieved similar long-term survival outcomes compared with posterolateral thoracotomy in c-N2 stage NSCLC patients.

Trial registration: Chinese Clinical Trial Registry ChiCTR-INR-17012777.

Keywords: Robotic-assisted thoracic surgery (RATS); lymph node metastasis; non-small cell lung cancer (NSCLC); postoperative complications; thoracotomy.