• Yajie Zhang, Chun Chen, Jian Hu, Yu Han, Maosheng Huang, Jie Xiang, and Hecheng Li.
• Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
• J. Thorac. Cardiovasc. Surg. 2020 Nov 1; 160 (5): 1363-1372.

ObjectivesAnatomical segmentectomy via robotic thoracic surgery and video-assisted thoracic surgery (VATS) are minimally invasive surgical approaches for treatment of early-stage non-small cell lung cancer (NSCLC). However, few research studies have compared early outcomes.MethodsA retrospective analysis was made of 774 patients, 298 who received robotic and 476 who received VATS, who underwent minimally invasive segmentectomy for early-stage NSCLC at 3 academic institutions between June 2015 and August 2019. Perioperative outcomes were compared after propensity score-matching on the basis of age, gender, body mass index, percent forced expiratory volume in 1 second, smoking status, American Society of Anesthesiologists score, type of segmentectomy, tumor size, and institution.ResultsThere were 257 patients in each group after propensity score-matching. The baseline characteristics and type of segmentectomy were comparable. Three conversions to thoracotomy occurred in the VATS group, and 1 in the robotic group (P = .624). There was no significant difference in operative time (147.91 ± 52.42 vs 149.23 ± 49.66 minutes; P = .773), blood loss (50 mL [interquartile range (IQR), 50-100 mL] vs 100 mL [IQR, 30-100 mL]; P = .177), rates of overall complications (17.9 vs 14.8%; P = .340), and length of stay (4 days [IQR, 3-5 days] vs 4 days [IQR, 3-5 days]; P = .417) between the robotic and VATS groups, respectively. Robotic segmentectomy was more costly ($12,019.30 ± 1678.30 vs $7834.80 ± 1291.20; P < .001) because of the amortization and consumables of the robotic system. There were a greater number of N1 lymph nodes and N1 stations in the robotic group.ConclusionsSegmentectomy with robotic and VATS are safe and feasible for early-stage NSCLC treatment. A robotic approach might lead to a better N1 lymph node dissection.Copyright © 2020 The American Association for Thoracic Surgery. All rights reserved.

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