Original article
General thoracic
A Comparative Analysis of Long-Term Survival of Robotic Versus Thoracoscopic Lobectomy

Presented at the Poster Session of the Fifty-sixth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 25-28, 2020.
https://doi.org/10.1016/j.athoracsur.2020.03.085Get rights and content

Background

Minimally invasive lobectomy can be performed robotically or thoracoscopically. Short-term outcomes between the 2 approaches are reported to be similar; however, the comparative oncological effectiveness is not known. We sought to compare long-term survival after robotic and thoracoscopic lobectomy.

Methods

We performed a propensity-matched analysis of SEER (Surveillance, Epidemiology and End Results)-Medicare patients with non-small cell lung cancer from 2008 to 2013 who underwent minimally invasive lobectomy using either a thoracoscopic (n = 3881) or a robotic-assisted (n = 426) approach. Patients in the 2 groups were propensity matched 1:1 based on demographics, comorbidities, treatment, and tumor characteristics. We compared the overall survival (OS) and cancer-specific mortality (CSM) between the 2 groups.

Results

Within the matched cohort (n = 409 per group), the median age at surgery was 73 (range, 65-91) years, with a median follow-up of 35 months postsurgery. There was no difference in OS or CSM between the thoracoscopic and robotic-assisted groups (OS: 71.4% vs 73.1% at 3 years, overall P = .366; CSM: 16.6% vs 14.9% at 3 years, overall P = .639).

Conclusions

Our propensity-matched analysis demonstrates that patients undergoing robotic-assisted lobectomy have similar OS and CSM compared with those patients undergoing thoracoscopic lobectomy. Oncologic outcomes are similar between the 2 minimally invasive approaches. These results demonstrate that further investigation is needed in the form of a randomized control trial, its variations, or additional large-scale registry analyses to verify these results.

Section snippets

Data Source

The SEER-Medicare dataset includes patient demographics, cancer diagnosis and treatment-related information, and cause of death linked to Medicare data. The Medicare linkage provides Medicare hospital, outpatient, physician, home health, and hospice claims. Medicare insures approximately 97% of people 65 years of age and older in the United States, allowing approximately 93% of that population in the SEER registry to be linked to the Medicare enrollment file.14,15 The current release contains

Patients

A total of 4307 patients undergoing lobectomy were identified (thoracoscopy: n = 3881; robotic-assisted: n = 426). Patient demographics, comorbidities, and tumor characteristics are listed in Table 1 for the matched cohort and in Supplemental Table 2 for the full cohort. Patients undergoing thoracoscopic and robotic-assisted lobectomy were similar in age, sex, median income, and the site of surgery. Patients undergoing thoracoscopic lobectomy were less likely to have coronary artery disease and

Comment

Our propensity-matched analysis of long-term OS and CSM after lobectomy suggests that there are no differences in long-term outcomes in patients undergoing robotic-assisted or thoracoscopic lobectomy. These minimally invasive lobectomy approaches also have similar in-hospital outcomes with the exception of mortality, which was higher in the thoracoscopic group.

Our results differ from those published from multiinstitutional case series, while supporting other single-institution case series (

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