Long-term survival of early-stage non–small cell lung cancer patients who underwent robotic procedure: a propensity score-matched study

BACKGROUND In the past decade, many researchers focused on to robot-assisted surgery. However, on long-term outcomes for patients with early-stage non-small cell lung cancer (NSCLC), whether the robotic procedure is superior to video-assisted thoracic surgery (VATS) and thoracotomy is unclear. Nonetheless, in the article titled "Long-term survival based on the surgical approach to lobectomy for clinical stage I non-small cell lung cancer: comparison of robotic, video assisted thoracic surgery, and thoracotomy lobectomy" by Yang et al. that was recently published in Annals of Surgery, the authors provided convincing evidence that the robotic procedure results in similar long-term survival as compared with VATS and thoracotomy. Minimally invasive procedures typically result in shorter lengths of hospital stay, and the robotic procedure in particular results in superior lymph node assessment. MAIN BODY Our propensity score-matched study generated high-quality data. Based on our findings, we see promise in expanding patient access to robotic lung resections. In this study, propensity score matching minimized the bias involved between groups. Nevertheless, due to its retrospective nature, bias may still exist. Currently, the concept of rapid rehabilitation is widely accepted, and it is very difficult to set up a randomized controlled trial to compare robotic, VATS, and thoracotomy procedures for the treatment of NSCLC. Therefore, to overcome this limitation and to minimize bias, the best approach is to use a registry and prospectively collected, propensity score-matched data. CONCLUSIONS Robotic lung resections result in similar long-term survival as compared with VATS and thoracotomy. Robot-assisted and VATS procedures are associated with short lengths of hospital stay, and the robotic procedure in particular results in superior lymph node assessment. Considering the alarming increase in the incidence of lung cancer in China, a nationwide database of prospectively collected data available for clinical research would be especially important.