Comparative Effectiveness of Robotic-Assisted Surgery for Resectable Lung Cancer in Older Patients

Abstract

Robotic-assisted surgery (RAS) is a novel surgical approach increasingly used for patients with non-small cell lung cancer (NSCLC). However, data comparing the effectiveness and costs of RAS vsopen thoracotomy and video-assisted thoracoscopic surgery (VATS) for NSCLC are limited. Patients > 65 years old with stage I to IIIA NSCLC treated with RAS, VATS, or open thoracotomy were identified from the Surveillance, Epidemiology, and End Results-Medicare database and matched according to age, sex, stage, and extent of resection. Propensity score methods were used to compare adjusted rates of postoperative complications, adequate lymph node staging, survival, and treatment-related costs. In this matched study cohort of 2,766 patients with resected NSCLC, RAS was associated with lower complication rates (OR, 0.57; 95%CI, 0.42-0.79) compared with open thoracotomy, and similar complication rates (OR, 1.02; 95%CI, 0.76-1.37) compared with VATS. Patients undergoing RAS were as likely to have adequate lymph node sampling as those undergoing open thoracotomy (OR, 1.28; 95%CI, 0.94-1.74) or VATS (OR, 0.88; 95%CI, 0.66-1.18). There was no significant difference in overall survival after RAS vsopen thoracotomy (hazard ratio, 0.81; 95%CI, 0.63-1.04) or VATS (hazard ratio, 0.91; 95%CI, 0.70-1.18). Costs were similar for RAS ($54,702) vsopen thoracotomy ($57,104; P= .08), and higher compared with VATS ($48,729; P= .02). RAS led to improved operative outcomes compared with open thoracotomy but may not offer an advantage over VATS. The comparative effectiveness of RAS should be further evaluated prior to widespread adoption.