Oncological clearance of minimally invasive lobectomy for clinical N0 non-small cell lung cancer: the role of robotic surgery

Robotic and video-assisted thoracic surgery (VATS) approaches are the procedures of choice for the radical treatment of patients affected by clinical early-stage non-small cell lung cancer (NSCLC). Several studies demonstrated better perioperative outcomes of minimally invasive techniques compared to open surgery. However, there is still a certain skepticism about long-term results of the robotic approach. In recent years, some studies demonstrated similar 5-year survival in patients undergoing robotic lobectomy for cN0 NSCLC compared to VATS and open surgery, overcoming 75% overall. These results were confirmed by a few multi-center trials. Moreover, robotic surgery was associated to nodal upstaging at final pathologic examination in a considerable proportion of patients undergoing lobectomy for cN0 disease. The high number of lymph nodes harvested during robotic surgery and, consequently, the more accurate pathologic staging allow the correct delivery of adjuvant therapies to patients. While several studies demonstrated comparable nodal upstaging in robotic and thoracotomic lobectomies, results are still unclear regarding nodal upstaging in VATS vs. robotic surgery. Further multi-center prospective studies are required to assess the potential long-term oncological superiority of robotic lobectomy for the treatment of early-stage NSCLC.