Robotic-assisted surgery demonstrated better outcomes compared with open thoracotomy, but may not have clear advantages over video-assisted thoracic surgery for non-small cell lung cancer (NSCLC), according to study results published in CHEST.

Rates of postoperative complications, adequate lymph node staging, survival, and treatment-related costs were obtained from the Surveillance, Epidemiology, and End Results-Medicare Database for patients undergoing surgery for NSCLC. These outcomes were compared between groups who received robotic-assisted surgery, open thoracotomy, or video-assisted thoracic surgery.

Among the 2766 patients with NSCLC undergoing surgery, 338 (12%) underwent robotic-assisted surgery, 1230 (45%) received video-assisted thoracic surgery, and 1198 (43%) were managed with open thoracotomy.

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Overall surgical complication rates were lower for patients undergoing robotic-assisted surgery compared with those treated with open thoracotomy, but there were no statistical differences in adequate lymph node staging or exploratory survival analyses. Compared with patients who underwent video-assisted thoracic surgery, those treated with robotic-assisted surgery had similar overall complication rates related to surgery. Costs were similar between robotic-assisted surgery and open thoracotomy ($54,702 vs $57,104; P =.08), but higher compared with video-assisted thoracic surgery ($48,729; P =.02).

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The study was limited by its observational design, its lack of random treatment allocation, and a lack of data on completeness of resection.

Although robotic-assisted surgery offered improved postoperative outcomes compared with open thoracotomy, video-assisted thoracic surgery did not. “As technology and operator experience with [robotic-assisted surgery] improve with time, continued reassessment of comparative effectiveness should be undertaken to ensure patients receive the most effective and safe surgical option,” the researchers wrote.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Veluswamy RR, Whittaker Brown S-A, Mhango G, et al. Comparative effectiveness of robotic-assisted surgery for resectable lung cancer in older patients [published October 4, 2019]. CHEST. doi:10.1016/j.chest.2019.09.017