• Rajwanth R Veluswamy, Stacey-Ann Whittaker Brown, Grace Mhango, Keith Sigel, Daniel G Nicastri, Cardinale B Smith, Marcelo Bonomi, Matthew D Galsky, Emanuela Taioli, Alfred I Neugut, and Juan P Wisnivesky.
• Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY; Institute of Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: rajwanth.veluswamy@mssm.edu.
• Chest. 2020 May 1; 157 (5): 1313-1321.

BackgroundRobotic-assisted surgery (RAS) is a novel surgical approach increasingly used for patients with non-small cell lung cancer (NSCLC). However, data comparing the effectiveness and costs of RAS vs open thoracotomy and video-assisted thoracoscopic surgery (VATS) for NSCLC are limited.MethodsPatients > 65 years old with stage I to IIIA NSCLC treated with RAS, VATS, or open thoracotomy were identified from the Surveillance, Epidemiology, and End Results-Medicare database and matched according to age, sex, stage, and extent of resection. Propensity score methods were used to compare adjusted rates of postoperative complications, adequate lymph node staging, survival, and treatment-related costs.ResultsIn this matched study cohort of 2,766 patients with resected NSCLC, RAS was associated with lower complication rates (OR, 0.57; 95% CI, 0.42-0.79) compared with open thoracotomy, and similar complication rates (OR, 1.02; 95% CI, 0.76-1.37) compared with VATS. Patients undergoing RAS were as likely to have adequate lymph node sampling as those undergoing open thoracotomy (OR, 1.28; 95% CI, 0.94-1.74) or VATS (OR, 0.88; 95% CI, 0.66-1.18). There was no significant difference in overall survival after RAS vs open thoracotomy (hazard ratio, 0.81; 95% CI, 0.63-1.04) or VATS (hazard ratio, 0.91; 95% CI, 0.70-1.18). Costs were similar for RAS ($54,702) vs open thoracotomy ($57,104; P = .08), and higher compared with VATS ($48,729; P = .02).ConclusionsRAS led to improved operative outcomes compared with open thoracotomy but may not offer an advantage over VATS. The comparative effectiveness of RAS should be further evaluated prior to widespread adoption.Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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