OBJECTIVES: In Japan, robotic assisted lobectomy (RAL) was awarded public reimbursement in April 2018, but there is limited evidence comparing RAL to conventional video-assisted thoracoscopic surgery (VATS). In this study, we compare the postoperative outcomes of VATS and RAL by using Japanese population-based dataset.

METHODS: Adult patients who underwent elective RAL or VATS with primary diagnosis of lung cancer from April 2018 to December 2021 were extracted from the Japan Medical Data Vision (MDV) database. We compared clinical outcomes including transfusion, surgical site infection (SSI), post-procedural pain claim rate (G89.18), ICU admission, Sequential Organ Failure Assessment (SOFA) score at ICU admission, post-operative complication (index/30/90days), discharge outcomes and readmission between RAL and VATS groups using 1:3 propensity score matching (PSM).

RESULTS: Among 20,615 patients (RAL:1,125 VATS:19,490), 1,125 RAL and 3,375 VATS patients were matched. RAL demonstrated lower rates in SSI (RAL 0.8%, VATS 2.7%, p<0.001) and pain claims (RAL 40.1%, VATS 47.5%, p<0.001). Overall post-operative complications rates were RAL 9.1% and VATS 8.4% (p=0.539) during hospitalization, RAL 4.4% and VATS 6.6% (p=0.01) after 30 days, and RAL 7.6% and VATS 11.7% (p<0.001) after 90 days of discharge. Respiratory and cardiac complications after 30 days were RAL 1.2% vs VATS 2.3% (p=0.021) and RAL 1.2% vs VATS 2.3% (p=0.039), respectively. ICU admission rate of RAL was significantly higher than VATS (RAL 32.7%, VATS 16.6%, p<0.001), but SOFA score at ICU admission date was lower in RAL (Mean RAL 11.20, VATS 14.41, p <0.001).

CONCLUSIONS: RAL was superior to VATS in terms of SSI, pain claims and discharge outcomes. Post-operative complications were comparable to VATS during hospitalization but showed better performance after 30 and 90 days from discharge with significantly lower complications in respiratory and cardiac complications.