Comparison of the perioperative outcomes between robotic-assisted thoracic surgery and video-assisted thoracic surgery in non-small cell lung cancer patients with different body mass index ranges

Background: Non-small cell lung cancer (NSCLC) is the most common malignancy and one of the most common causes of cancer-related death worldwide. Robotic-assisted thoracic surgery (RATS) has gradually become a prevalent surgical method for patients with NSCLC. Previous studies have found that body mass index (BMI) is associated with postoperative outcomes. This study aimed to investigate the effectiveness of RATS compared to video-assisted thoracic surgery (VATS) in the treatment of NSCLC with different BMI, in terms of perioperative outcomes.Methods: The baseline and perioperative data, including BMI, of 849 NSCLC patients who underwent minimally invasive anatomic lung resections from August 2020 to April 2021 were retrospectively collected and analyzed. Propensity score matching analysis was applied to minimize potential bias between the two groups (VATS and RATS), and the perioperative outcomes were compared. Subgroup analysis was subsequently performed.Results: Compared to VATS, RATS had more lymph nodes dissected 19 [inter-quartile range (11QR), 6-12] vs. 7 (IQR, 6-10), P<0.001), a lower estimated bleeding volume [40 (IQR, 30-50) vs. 50 (IQR, 40-60) mL, P<0.001], and other better postoperative outcomes, but a higher cost of hospitalization [(sic)83,626 (IQR, 77,211-92,686) vs. (sic)75,804 (IQR, 66,184-83,693), P<0.001]. Multivariable logistic regression analysis indicated that RATS (P=0.027) and increasing BMI (P=0.030) were associated with a statistically significant reduction in the risk of postoperative complications. Subgroup analysis indicated that the advantages of RATS may be more obvious in patients with a BMI of 24-28 kg/m(2), in which the RATS group had more lymph nodes dissected [9 (IQR, 6-12) vs. 7 (IQR, 5-10), P<0.001] and a decreased risk of total postoperative complications [odds ratio (OR), 0.443; 95% confidence interval (CI), 0.212-0.924; P=0.030] compared to the VATS group.Conclusions: Both, RATS and VATS can be safely applied for patients with NSCLC. Perioperative outcome parameters indicate advantages for RATS, however at a higher cost of hospitalization. The advantages of RATS might be more obvious in patients with a BMI of 24-28 kg/m(2).