Impact of minimally invasive surgical approach on oncological completeness of resection in lung cancer surgery.

[OBJECTIVES] Oncological radicality, defined as complete resection, is essential in lung cancer surgery. This study aimed to compare the oncological quality of anatomical lung resections performed via video-assisted thoracoscopic surgery (VATS) versus robotic-assisted thoracic surgery (RATS), focusing on completeness of resection. Secondary objectives included lymphadenectomy quality, nodal upstaging, residual disease, and the number of dissected lymph node stations and retrieved lymph nodes.

[METHODS] A prospective single-center study included consecutive patients undergoing minimally invasive anatomical lung resection for lung cancer (September 2023-April 2025). Overlap weighting based on propensity scores-calculated using histology, clinical T and N stage, and extent of resection-was applied. Outcomes related to oncological radicality were compared between the VATS and RATS groups using appropriate statistical tests based on variable type and distribution.

[RESULTS] Of 358 patients, 255 met the inclusion criteria (84 RATS, 171 VATS). The rates of complete, incomplete, and uncertain resection were 62.0 %, 3.5 %, and 34.5 %, respectively. After overlap weighting, no significant differences were observed between RATS and VATS in complete resection (66.5 % vs. 60 %, p = 0.557), residual disease (2.17 % vs. 1.92 %, p = 0.802), adequate lymphadenectomy (70.7 % vs. 61.8 %, p = 0.181), or nodal upstaging (19.7 % vs. 11.3 %, p = 0.087). However, RATS yielded a higher number of mediastinal nodal stations dissected (median: 4 vs. 3, p < 0.001) and lymph nodes retrieved (median: 9 vs. 7, p < 0.001).

[CONCLUSIONS] RATS and VATS achieved similar oncological radicality. However, RATS was associated with more extensive lymphadenectomy, potentially improving staging accuracy.