Robot-assisted thoracoscopic surgery versus thoracotomy for c-N2 stage NSCLC: short-term outcomes of a randomized trial

Jia Huang, Chongwu Li, Hecheng Li, Fanzhen Lv, Long Jiang, Hao Lin, Peiji Lu, Qingquan Luo, Wenrong Xu


Background: Safety and short-term efficacy of robot-assisted thoracoscopic surgery (RATS) for early-stage non-small cell lung cancer (NSCLC) have been previously proven; however, RATS for N2 stage NSCLC was barely evaluated. The aim of this randomized controlled trial (RCT) was to explore the short-term outcome of RATS for cN2 stage NSCLC.
Methods: Total of 113 patients who were diagnosed with clinically single cN2 stage NSCLC were enrolled and randomly assigned to RATS and thoracotomy groups. The patients in RATS group were treated by lobectomy and mediastinal lymph node dissection using the da Vinci Surgical System, while the patients in thoracotomy group underwent lobectomy and mediastinal lymph node dissection from. And, short-term outcomes were analyzed statistically.
Results: The data from 108 subjects (58 in RATS and 55 in thoracotomy groups) were eligible for analyses. Five patients who received robot-assisted lobectomy initially was converted intraoperatively to open operation due to extensive pleural adhesion and equipment issues. And, one subject underwent robot-assisted surgery was died preoperatively due to pulmonary embolism. Compared with thoracotomy, RATS was associated with less intraoperative blood loss (86.3±41.1 vs. 165.7±46.4 mL, P<0.001), median chest duration (4 vs. 5, P<0.01), visual analog scores at postoperative day one to five (P<0.001), and slightly fewer incidence of postoperative complications. Also, both surgical approaches revealed comparable drainages and nodal harvest. The cancer residual margins occurred in one subject in RATS group and three patients in thoracotomy group (P=0.56). However, overall cost of subjects underwent RATS was higher than those received thoracotomy (100,367±19,251 vs. 82,002±20,434, P<0.001).
Conclusions: Present study proves that the feasibility and safety of RATS lobectomy to treat patients with cN2 stage NSCLC, and it should be superior to thoracotomy due to lesser intraoperative blood loss.