Robotic-assisted thoracic surgery versus video-assisted thoracic surgery for patients undergoing lung resection: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Minimally invasive techniques have mostly replaced open thoracotomy for lung resection, yet their comparative benefits remain unclear. We performed a systematic review and meta-analysis to evaluate clinical outcomes associated with robot-assisted (RATS) and video-assisted thoracic surgery (VATS).

Methods: We searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing RATS to VATS in patients undergoing lung resection. Primary outcomes were conversion to thoracotomy and overall complications. Risk ratios (RR) and mean differences (MD) were used for categorical and continuous outcomes, respectively, considering as significant p-values < 0.05. Trial sequential analysis was also conducted.

Results: We included five RCTs comprising 712 patients, of whom 338 (47.5%) underwent RATS, and 374 (52.5%) underwent VATS. No differences were found between groups in conversion to thoracotomy (RR 0.65; 95% CI 0.36-1.20; p = 0.17) and overall complications (RR 0.91; 95% CI 0.69-1.21; p = 0.49). RATS presented a higher number of lymph node stations resected (p < 0.00001) and a shorter length of hospital stay after performing sensitivity analysis (p < 0.00001). There were no differences between RATS and VATS in any of the other secondary outcomes.

Conclusion: Our study results reassure the safety and potential benefits associated with RATS lung resections, demonstrating a significantly higher number of lymph node stations resected and a possible trend toward shorter hospital stays, with similar rates of complications and conversion in comparison to VATS.

Keywords: Lung cancer; Lung resection; Robot-assisted thoracic surgery; Video-assisted thoracic surgery.