Robotic Versus Video-Assisted Thoracoscopic Lobectomy/Segmentectomy: Multilevel Analysis in Japan.

[OBJECTIVES] Large-scale comparative data on the perioperative safety of robotic-assisted thoracoscopic surgery and video-assisted thoracoscopic surgery in Asia are limited. We compared the perioperative outcomes of these 2 approaches for lung cancer.

[METHODS] This retrospective study used data from the Diagnostic Procedure Combination database in Japan. We included 47 541 patients who underwent lobectomy or segmentectomy for lung cancer from 2018 to 2021 and performed multivariable analyses.

[RESULTS] Among 47 541 patients, 2835 underwent robotic-assisted thoracoscopic surgery. Perioperative mortality did not differ significantly between groups (incidence rate ratio, 1.71; 95% CI, 0.88-3.33). Robotic-assisted surgery was associated with longer anaesthesia time and a higher incidence of mechanical ventilation postoperatively (incidence rate ratio, 1.96; 95% CI, 1.36-2.81), although the absolute difference was small (Marginal risk difference, +0.52 percentage points; 95% CI, +0.14 to +0.91). No significant differences were observed in other major complications, reoperation, or hospital stay.

[CONCLUSIONS] In this large, real-world Japanese cohort including the early experience with robotic surgery, overall perioperative safety was comparable between robotic-assisted and video-assisted thoracoscopic surgery, although a statistically significant but small absolute increase in postoperative ventilation was observed with the robotic approach. This association remained robust across a series of sensitivity analyses. However, it is likely influenced by unmeasured confounding. Future prospective studies should investigate specific procedural factors, including anaesthetic management and patient selection, to optimize outcomes.