Abstract
Background. The aim of this work is to assess the quality of observational studies and to make direct and indirect comparisons of robotic surgery with other approaches.Method. We searched various databases between 2014 and 2024 for observational studies comparing robotic-assisted surgery to thoracoscopy or thoracotomy.Results. Eighteen studies were included in the meta-analysis. Risk of confounding bias was present in 90% of studies, while risk of classification bias appeared in 80%. Robotic-assisted surgery reduced the risk of conversion to thoracotomy compared with thoracoscopy with an odds ratio of 0.21 (95% confidence interval: 0.06 - 0.65), with high heterogeneity between studies (I2 = 80%). Robotic-assisted surgery did not significantly reduce postoperative complications or 30-day mortality compared with thoracotomy or thoracoscopy. For 5-year overall survival, comparisons of robotic-assisted surgery to thoracoscopy or thoracotomy were non-significant with I2 of 55%.Conclusion. This work demonstrates the need for a randomized controlled trial to validate robotic surgery for the treatment of bronchial cancer.
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