Comparison of Robotic-Assisted and Uniportal Video-Assisted Thoracoscopic Lobectomy for Early-Stage Non-Small Cell Lung Cancer: A Retrospective Cohort Study.

[AIM] This study aimed to compare perioperative outcomes, lymphadenectomy quality, postoperative recovery, pulmonary function, and short-term oncologic results between robotic-assisted thoracoscopic surgery (RATS) and uniportal video-assisted thoracoscopic surgery (U-VATS) for early-stage non-small cell lung cancer (NSCLC).

[METHODS] This retrospective cohort study included 231 consecutive patients with stage I-IIA NSCLC who underwent curative-intent anatomic lobectomy at our institution between January and December 2023. Based on the surgical approach, patients were assigned to either the RATS group (n = 105) or the U-VATS group (n = 126). All procedures were performed by the same experienced surgical team using standardized perioperative protocols. Clinical characteristics, intraoperative and postoperative parameters, pulmonary function, and 12-month oncologic outcomes were collected for comparative evaluation.

[RESULTS] RATS resulted in shorter operative time, reduced blood loss, and increased lymph node and mediastinal station retrieval compared with U-VATS. Postoperative pain, drainage volume, length of hospital stay, and complication rates were comparable between groups. Patients undergoing RATS demonstrated significantly higher global health and functional scores, along with lower symptom scores, during the first 6 months after surgery ( < 0.05). Pulmonary function recovery, 1-year disease-free survival (DFS), and overall survival (OS) did not differ significantly between the two approaches. However, hospitalization costs were higher for the RATS group ( < 0.001).

[CONCLUSIONS] Both RATS and U-VATS are safe and effective minimally invasive approaches for anatomic lobectomy in early-stage NSCLC. RATS offers advantages in operative precision, lymph node dissection, and short-term quality of life without compromising safety or early oncologic outcomes, although it is associated with increased cost.