Impact of robotic access on outcomes after lung cancer surgery in France: Analysis from the Epithor database.

Introduction: We aimed to compare postoperative outcomes after pulmonary resection for lung cancer after open thoracotomy (OT), video-assisted (VATS), and robotic-assisted (RA) thoracic surgery using a propensity score analysis.

Methods: From 2010 to 2020, 38,423 patients underwent resection for lung cancer. In total, 58.05% (n = 22,306) were operated by thoracotomy, 35.35% (n = 13,581) by VATS, and 6.6% (n = 2536) by RA. A propensity score was used to create balanced groups with weighting. End points were in-hospital mortality, postoperative complications, and length of hospital stay, reported by odds ratios (ORs) and 95% confidence intervals (CIs).

Results: VATS decreased in-hospital mortality compared with OT (OR, 0.64; 95% CI, 0.58-0.79;  < .0001) but not compared with RA (OR, 1.09; 95% CI, 0.77-1.52;  = .61). VATS reduced major postoperative complications compared with OT (OR, 0.83; 95% CI, 0.76-0.92;  < .0001) but not RA (OR, 1.01; 95% CI, 0.84-1.21;  = .17). VATS reduced prolonged air leaks rate compared with OT (OR, 0.9; 95% CI, 0.84-0.98;  = .015) but not RA (OR, 1.02; 95% CI, 0.88-1.18;  = .77). As compared with OT, VATS and RA decreased the incidence of atelectasis (respectively: OR, 0.57; 95% CI, 0.50-0.65;  < .0001 and OR, 0.75; 95% CI, 0.60-0.95;  = .016); the incidence of pneumonia (OR, 0.75; 95% CI, 0.67-0.83;  < .0001 and OR, 0.62; 95% CI, 0.50-0.78;  < .0001); and the number of postoperative arrhythmias (OR, 0.69; 95% CI, 0.61-0.78;  < .0001 and OR, 0.75; 95% CI, 0.59-0.96;  = .024). Both VATS and RA resulted in shorter hospital stays (-1.91 days [-2.24; -1.58];  < .0001 and -2.73 days [-3.1; -2.36];  < .0001, respectively).

Conclusions: RA appeared to decrease postoperative pulmonary complications as well as VATS compared with OT. VATS decreased postoperative mortality as compared with RA and OT.