Long-Term Patient-Reported Outcomes after Multiport Robot-Assisted Surgery versus Video-Assisted Surgery for Lung Cancer: An Observational Cohort Study.

[BACKGROUND] The purpose of this study was to compare patient-reported outcomes (PROs) and perioperative clinical outcomes during 1 year post surgery between robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS), including multiportal (M-VATS) and uniportal (U-VATS) approaches, in patients with lung cancer.

[METHODS] Data from a prospective cohort study (CN-PRO-Lung3) were analyzed, and patients with primary lung cancer who underwent RATS or VATS were included. Primary outcomes were postoperative symptoms and daily functioning assessed using the Perioperative Symptom Assessment (PSA)-Lung, and exploratory outcomes included health-related quality of life (HRQoL) based on the Five-Level EuroQol Five-Dimensional Questionnaire and other clinical outcomes. Propensity score matching (PSM) was adjusted for baseline differences.

[RESULTS] After the PSM of 687 patients, 91 patients were matched between RATS and M-VATS and 119 between RATS and U-VATS. Compared with those undergoing M-VATS, patients undergoing RATS reported lower rates of moderate-to-severe fatigue (P = 0.017) and disturbed sleep (P = 0.049) in the hospital. Additionally, RATS demonstrated better clinical outcomes, including more lymph-node dissections (P < 0.001), less blood loss (P < 0.001), shorter operative time (P < 0.001), and reduced hospital stays (P < 0.001) than M-VATS but incurred higher costs (P < 0.001). Compared with those undergoing U-VATS, patients undergoing RATS reported higher rates of moderate-to-severe cough (P = 0.007) and slower initial HRQoL recovery after discharge.

[CONCLUSIONS] Compared with M-VATS, RATS offers perioperative advantages, including reduced symptoms and better clinical outcomes, but at higher costs. Compared with U-VATS, RATS enhanced lymph-node dissection rates but increased postoperative cough and slowed HRQoL recovery. This study highlights the importance of incorporating PROs into surgical decision-making. Clinical registration ChiCTR2000033016 ( https://www.chictr.org.cn/searchprojEN.html ).