598 Video-Assisted Thoracoscopic Surgery Versus Robot-Assisted Thoracoscopic Surgery in Early-Stage Lung Cancer: A Systematic Review and Meta-Analysis

摘要

Abstract Aim Video-assisted thoracic surgery (VATS) remains the main surgical procedure for lung cancer resection. However, it is associated with technical limitations and a steep learning curve. Hence, alternative approaches like robot-assisted thoracic surgery (RATS) have been explored. This review aims to compare the clinical outcomes of VATS versus RATS in early-stage lung cancer patients. Method A systematic, electronic search was performed according to PRISMA guidelines to identify relevant articles that compared outcomes of the VATS versus RATS procedures in patients with early-stage lung cancer. Results Seventeen studies were identified, enrolling 17,111 patients. The mean tumor size was 12.58±7.21cm in the RATS group and 5±2.5cm in the VATS group, with most patients in the Stage 1 cancer group. The primary outcomes, length of hospital stay (MD 0.37, 95% CI [-0.15, 0.89], and conversion (OR 0.99, 95% CI [0.68, 1.43]), were not statistically significant. Although more lymph nodes were retrieved during the RATS procedure (MD -0.70, 95% CI [-1.18, -0.21]), no significant differences were observed in other secondary outcomes such as operative duration (MD -0.14, 95% CI [-1.00, 0.73]), reintervention (OR 1.47, 95% CI[0.22, 9.79]), infection (OR 0.89, 95% CI [0.52, 1.54]), and bleeding (OR 1.15, 95% CI [0.52, 2.55]). Conclusions The RATS and VATS procedures have comparable outcomes, thus proving the RATS procedure to be a safe alternative. However, the technical feasibility and cost-effectiveness need to be thoroughly studied. This review calls for robust trials comparing the two techniques to further evaluate the value of the RATS procedure in early-stage lung cancer.