Bi-port robotic versus uniportal thoracoscopic lobectomy for non-small cell lung cancer: a propensity score matching analysis

The comparison of perioperative outcomes between uniportal video-assisted thoracic surgery (UVATS) and bi-port robotic-assisted thoracic surgery (bi-port RATS) in non-small cell lung cancer (NSCLC) has received limited attention in the literature, with few reports directly comparing these two minimally invasive thoracic surgical approaches, emphasizing the need for further research. We conducted a retrospective data analysis of 427 patients who underwent minimally invasive lobectomies (UVATS ( n = 295) versus bi-port RATS ( n = 132)) performed by the same surgical team and pathologically diagnosed with stage I–IIIA NSCLC from January 2021 to August 2023. To mitigate potential bias, we compared perioperative outcomes following propensity score matching (PSM) analysis. After PSM, 101 pairs of patients were successfully matched. There were no significant differences in conversion rate, numerical rating scale scores, additional opioids use, blood loss, nodal upstaging, and postoperative complications between the UVATS and bi-port RATS groups. In the UVATS group, operation time was shorter (127.77 vs. 117.83 min, P = 0.040), and hospitalization expenditure ($8763.01 vs. $7551.27, P < 0.001) as well as out-of-pocket costs ($5122.82 vs. $2953.38, P < 0.001) was lower. However, the bi-port RATS group exhibited less drainage on postoperative day 1 (103.71 vs. 127.23 mL, P = 0.026), shorter postoperative length of stay (4.92 vs. 6.74 days, P = 0.002), reduced draining time (2.94 vs. 4.74 days, P < 0.001), and more N1 lymph nodes retrieved (6.20 vs. 5.60, P = 0.031). Bi-port RATS combines the advantages of robotic technology with UVATS surgical experience, demonstrating comparable safety and superior recovery outcomes in minimally invasive surgery for early-stage NSCLC albeit at a higher cost, compared to UVATS.