Abstract
We compare the perioperative course, postoperative pain, and quality-of-life (QOL) in patients undergoing anatomic resections of early-stage lung cancer by means of robotic surgery (RATS), video-assisted thoracic surgery (VATS), or muscle-sparing thoracotomy (OPEN); 169 consecutive patients with known/suspected lung cancer, candidates to anatomic resection, were enrolled in a single-center prospective study from April 2016 to December 2018. EORTC QLQ-C30 and QLQ-LC13 scores were obtained preoperatively and, at three time points, postoperatively. RATS and VATS groups were matched for ASA scores, while RATS and open surgery were matched for gender, ASA score, cancer stage, and tumor size; 58 patients underwent open surgery, 58 had VATS, and 53 had RATS. Hospital stay was shorter after RATS than OPEN (median 4.5 versus 5; p = 0.047). Comparing matched RATS and VATS groups, the number of hilar lymph nodes and nodal stations removed was significantly higher in the former approach (p = 0.01 vs. p < 0.0001); conversely, pain at 2 weeks was slightly lower after VATS (p = 0.004). No significant difference was observed in conversions, complications, duration of surgery, and postoperative hospitalization. The robotic approach was superior to OPEN in terms of QOL, pain, and length of postoperative stay and showed improved lymph node dissection compared to VATS.
Highlights
In the randomized trial published by Bendixen in 2017 [8], video-assisted thoracic surgery (VATS) was shown to be superior in terms of pain and quality-of-life (QOL)
Robotic surgery using the da Vinci system represents a technological evolution of the videothoracoscopic approach and is advantageous in terms of a better view of the operative field (3D instead of 2D), more intuitive use of the tools, and finer instrument precision, with a wider range of movements that is superior to that of the human hand [10,11]
No significant difference was observed in conversions, complications, duration of surgery, and postoperative stay (Table 6)
Summary
Many pieces of evidence from retrospective and randomized controlled trials suggest that using minimally invasive approaches for the treatment of early-stage lung cancer is related to many clinical advantages in terms of perioperative outcomes with respect to open surgery [1,2,3,4,5,6,7]. Robotic surgery using the da Vinci system represents a technological evolution of the videothoracoscopic approach and is advantageous in terms of a better view of the operative field (3D instead of 2D), more intuitive use of the tools, and finer instrument precision, with a wider range of movements that is superior to that of the human hand [10,11]
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