Comparison of RATS Lobectomy and VATS Lobectomy for Early-stage Non-small Cell Lung Cancer

Background/Aim: Robotic-assisted thoracoscopic surgery (RATS) for pulmonary resection of early-stage non-small cell lung cancer (NSCLC) has been increasingly adopted worldwide. To evaluate its safety and oncological efficacy, we compared the outcomes of RATS and video-assisted thoracoscopic surgery (VATS) lobectomy in patients with stage 0 or I NSCLC. Patients and Methods: Between August 2014 and December 2024, 330 patients with stage 0 or I NSCLC underwent pulmonary lobectomy via RATS (n=144) or VATS (n=186). RATS was performed using the da Vinci Xi system and VATS was performed using a conventional multiport technique. The perioperative and clinicopathological outcomes were retrospectively evaluated and analyzed after propensity score matching. Results: The baseline characteristics were similar between the groups. The RATS group included more right upper lobectomies and fewer left upper lobectomies than the VATS group. Intraoperative blood loss was significantly lower in the RATS group. There were no significant differences in operative time, chest tube duration, postoperative complications, or length of hospital stay. Regarding lymph node (LN) dissection, the RATS group showed significantly higher numbers of dissected and total harvested LNs in the overall cohort. However, after propensity score matching, the LN yields were comparable between the groups. Conclusion: Both RATS and VATS lobectomies were safely performed for early-stage NSCLC. RATS achieved perioperative outcomes comparable to those achieved with VATS, with a reduced intraoperative blood loss. The lymph node harvest was similar after propensity score matching, suggesting that RATS provides oncological quality equivalent to that of VATS.