Robotic sleeve lobectomy for centrally located non-small cell lung cancer: A propensity score-weighted comparison with thoracoscopic and open surgery.

OBJECTIVE: To evaluate the surgical and oncologic outcomes of robotic sleeve lobectomy in comparison with video-assisted thoracoscopic surgery (VATS) and open surgery.

METHODS: Surgical outcomes in patients with non-small cell lung cancer who underwent sleeve lobectomy via robotic, VATS, and thoracotomy were assessed using the χ2 test, Fisher exact test, and the Kruskal-Wallis rank sum test. Log-rank test and Cox proportional hazards model were used in survival analyses. Propensity score-weighted matching was used to achieve the balance of baseline among the 3 groups.

RESULTS: Between 2012 and 2017, 188 patients were included and divided into robotic (n = 49), VATS (n = 73), and open (n = 66) groups. After weighted matching that retained all patients, no statistical difference in 90-day mortality or morbidity among the 3 groups was shown. Patients in the robotic group had less bleeding loss (P < .001), operative time (P < .001), and tube drainage time (P < .001) than the other 2 groups. No positive bronchial margin or conversion presented in the robotic group. In multivariable analyses, surgical technique was independently associated with neither overall survival nor disease-free survival (P > .050).

CONCLUSIONS: Robotic sleeve lobectomy is a safe, feasible, and effective procedure. Compared with VATS and open techniques, robotic sleeve lobectomy has a similar oncologic prognosis for patients with centrally located non-small cell lung cancer. Further studies with a larger sample size and long-term follow-up are needed.