Mortality for Robotic- vs Video-Assisted Lobectomy-Treated Stage I Non-Small Cell Lung Cancer Patients

Background: To address the US Food and Drug Administration's recent safety concern on robotic surgery procedures, we compared short- and long-termmortality for stage I non-small cell lung cancer (NSCLC) patients treated by robotic-assisted thoracoscopic surgical lobectomy (RATS-L) vs video-assisted thoracoscopic surgical lobectomy (VATS-L). Methods: From the National Cancer Database, we identified 18 908 stage I NSCLC patients who underwent RATS-L or VATS-L as the primary operation from 2010 to 2014. Cox proportional hazards models were used to estimate hazard ratios (HRs) for short-and long-term mortality using unmatched and propensity score-matched analyses. All statistical tests were 2-sided. Results: Patients treated by RATS-L had higher 90-day mortality than those with VATS-L (6.6% vs 3.8%, P =.03) if conversion to open thoracotomy occurred. After excluding first-year observation, multiple regression analyses showed RATS-L was associated with increased long-term mortality, compared with VATS-L, in cases with tumor size 20mmor less: hazard ratio (HR) = 1.33 (95% confidence interval [CI] = 1.15 to 1.55), HR = 1.36 (95% CI = 1.17 to 1.58), and HR = 1.33 (95% CI = 1.11 to 1.61) for unmatched, N:1 matched, and 1:1matched analyses, respectively, in the intention-to-treat analysis. Among patients without conversion to an open thoracotomy, the respective hazard ratios were 1.19 (95% CI = 1.10 to 1.29), 1.19 (95% CI = 1.10 to 1.29), and 1.17 (95% CI = 1.06 to 1.29). Similar associations were observedwhen follow-up time started 18 or 24months postsurgery. No statistically significantmortality difference was found for patients with tumor size of greater than 20mm. These associations were not related to case volume of VATS-L or RATS-L performed at treatment institutes. Conclusions: Patients with small (<= 20mm) stage I NSCLC treated with RATS-L had statistically significantly higher long-termmortality risk than VATS-L after 1 year postsurgery.