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. 2025 Jan 21:24:383-393.
doi: 10.1016/j.xjon.2025.01.007. eCollection 2025 Apr.

Quality of life outcomes after robotic-assisted and video-assisted thoracoscopic surgery for early-stage non-small cell lung cancer

Jiafang Zhang  1 , Rowena Yip  1 , Emanuela Taioli  2   3   4   5 , Raja M Flores  2   4   5 , Claudia I Henschke  1   4   5   6 , David F Yankelevitz  1   4   5 , Rebecca M Schwartz  3   4   7 ; IELCART Investigators
Collaborators, Affiliations

Quality of life outcomes after robotic-assisted and video-assisted thoracoscopic surgery for early-stage non-small cell lung cancer

Jiafang Zhang et al. JTCVS Open. .

Abstract

Background: Limited research exists comparing the impacts of robotic-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) on patients' physical and mental health-related quality of life (QoL).

Methods: A prospective cohort of stage IA non-small cell lung cancer (NSCLC) patients in the Initiative for Early Lung Cancer Research on Treatment from Mount Sinai Health System had QoL measured before surgery and at 2, 6, and 12 months post-treatment using the Medical Outcomes Study Short-Form 12 (SF-12), with Physical Component Summary (PCS) and Mental Component Summary (MCS); the Functional Assessment of Cancer Therapy-Lung Cancer Subscale (FACT-LCS); and Patient Health Questionnaire-4 (PHQ-4; for depression/anxiety). A locally weighted smoothing curve was fitted to identify the best interval knot for post-treatment QoL trends. A piecewise linear mixed-effects model was developed to estimate differences in baseline, 2-month, and 12-month QoL scores and rates of change, adjusting for age, sex, race, ethnicity, smoking status, pack-years, nodule size/consistency, comorbidities, and surgical extent.

Results: The study cohort comprised 698 patients, including 458 (65.6%) who underwent VATS and 240 (34.4%) who underwent RATS. The RATS group exhibited a more significant initial decline in physical health at 2 months post-surgery but showed significant recovery by 12 months, achieving similar or slightly higher physical scores compared to baseline. No significant differences in mental health scores over time were seen between the groups. Both groups displayed consistent anxiety and depression scores, with significant improvements in anxiety symptoms at the 2-month mark. The RATS group had fewer postoperative complications and conversion to open thoracotomy.

Conclusions: RATS and VATS offer similar long-term QoL outcomes for early-stage NSCLC patients, though RATS patients may experience a sharper initial decline in physical health.

Keywords: non–small cell lung cancer; quality of life; robotic-assisted thoracic surgery; surgery; video-assisted thoracic surgery.

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Conflict of interest statement

Dr Yankelevitz is a named inventor on a number of patents and patent applications related to the evaluation of chest diseases, including measurements of chest nodules. Dr Yankelevitz has received financial compensation for the licensing of these patents. In addition, he is a consultant and co-owner of Accumetra, a private company developing tools to improve the quality of CT imaging. He is on the advisory board and owns equity in HeartLung, a company that develops software related to CT scans of the chest. He is on the medical advisory board of Median Technology, which is developing technology related to analyzing pulmonary nodules, and is on the medical advisory board of Carestream, a company that develops radiography equipment. He also is on the medical advisory board for LungLife AI. Dr Henschke is an inventor of patents and pending patents owned by Cornell Research Foundation. As of April 2009, she has divested herself of all royalties and other interests arising from these. She is on the medical advisory board for LungLife AI. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

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Graphical abstract
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Estimated marginal means of PCS for RATS and VATS patients.
Figure 1
Figure 1
Estimated marginal means of the 12-item Short-Form Health Survey (SF-12) Physical Component Score (PCS) score at baseline and 2 months and 12 months postsurgery. QoL, Quality of life; VATS, video-assisted thoracic surgery; RATS, robotic-assisted thoracic surgery.
Figure 2
Figure 2
Estimated marginal means of the 12-item Short-Form Health Survey (SF-12) Mental Component Score (MCS) score at baseline and 2 months and 12 months postsurgery. QoL, Quality of life; VATS, video-assisted thoracic surgery; RATS, robotic-assisted thoracic surgery.
Figure 3
Figure 3
Estimated marginal means of Functional Assessment of Cancer Therapy–Lung Cancer Subscale (FACT-LCS) score at baseline and 2 months and 12 months postsurgery. QoL, Quality of life; FLLCS, Functional Assessment of Cancer Therapy-Lung Cancer Subscale; VATS, video-assisted thoracic surgery; RATS, robotic-assisted thoracic surgery.
Figure 4
Figure 4
Estimated marginal means of Generalized Anxiety Disorder 2-item scale (GAD-2) score at baseline and 2 months and 12 months postsurgery. QoL, Quality of life; VATS, video-assisted thoracic surgery; RATS, robotic-assisted thoracic surgery.
Figure E1
Figure E1
Estimated marginal means of Patient Health Questionnaire-2 item scale (PHQ-2) scores at baseline and 2 months and 12 months postsurgery. QoL, Quality of life; VATS, video-assisted thoracic surgery; RATS, robotic-assisted thoracic surgery.
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