title: Comparison of Video-Assisted Thoracoscopic Surgery and Robotic Approaches for Clinical Stage I and Stage II Non-Small Cell Lung Cancer Using The Society of Thoracic Surgeons Database.
abstract: BACKGROUND
  Data from selected centers show that robotic lobectomy is safe and effective and has 30-day mortality comparable to that of video-assisted thoracoscopic surgery (VATS). However, widespread adoption of robotic lobectomy is controversial. We used The Society of Thoracic Surgeons General Thoracic Surgery (STS-GTS) Database to evaluate quality metrics for these 2 minimally invasive lobectomy techniques.
  
  
  METHODS
  A database query for primary clinical stage I or stage II non-small cell lung cancer (NSCLC) at high-volume centers from 2009 to 2013 identified 1,220 robotic lobectomies and 12,378 VATS procedures. Quality metrics evaluated included operative morbidity, 30-day mortality, and nodal upstaging, defined as cN0 to pN1. Multivariable logistic regression was used to evaluate nodal upstaging.
  
  
  RESULTS
  Patients undergoing robotic lobectomy were older, less active, and less likely to be an ever smoker and had higher body mass index (BMI) (all p < 0.05). They were also more likely to have coronary heart disease or hypertension (all p < 0.001) and to have had preoperative mediastinal staging (p < 0.0001). Robotic lobectomy operative times were longer (median 186 versus 173 minutes; p < 0.001); all other operative measurements were similar. All postoperative outcomes were similar, including complications and 30-day mortality (robotic lobectomy, 0.6% versus VATS, 0.8%; p = 0.4). Median length of stay was 4 days for both, but a higher proportion of patients undergoing robotic lobectomy had hospital stays less than 4 days (48% versus 39%; p < 0.001). Nodal upstaging overall was similar (p = 0.6) but with trends favoring VATS in the cT1b group and robotic lobectomy in the cT2a group.
  
  
  CONCLUSIONS
  Patients undergoing robotic lobectomy had more comorbidities and robotic lobectomy operative times were longer, but quality outcome measures, including complications, hospital stay, 30-day mortality, and nodal upstaging, suggest that robotic lobectomy and VATS are equivalent.
authors.affiliation: Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington. Electronic address: brian.louie@swedish.org.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Louie
authors.affiliation: Division of Thoracic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wilson
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Sunghee
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Cerfolio
authors.affiliation: Division of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Park
authors.affiliation: Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Farivar
authors.affiliation: Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington.
authors.forename: Eric
authors.initials: E
authors.lastname: Vallières
authors.affiliation: Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington.
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Aye
authors.affiliation: Division of Thoracic Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: William R
authors.initials: WR
authors.lastname: Burfeind
authors.affiliation: Division of Thoracic Surgery, Memorial Healthcare System, Hollywood, Florida.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Block
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D065287:Robotic Surgical Procedures / Q000379:methods*; D066231:Surgeons; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*