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

Abstract

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.