Short-term outcomes of robotic- vs. television-assisted thoracoscopic segmental lung resection for early-stage non-small-cell lung cancer in the day surgery models.

Abstract

Background: At present, few articles compare the differences between robot-assisted thoracic surgeries (RATSs) and video-assisted thoracic surgeries (VATSs) in the day surgery model and there is also little literature on what factors influence delayed discharge from day surgery. This study aims to compare short-term outcomes between RATS and VATS for segmental lung resection in a day surgery setting, and to identify risk factors for delayed discharge.

Methods: A retrospective analysis was performed on 204 patients with early-stage non-small-cell lung cancer (NSCLC) who underwent segmental lung resection via RATS or VATS at the First People's Hospital of Changzhou City from January 2021 to December 2023. The clinical data and short-term efficacy of the two groups were compared, and the patients were divided into two subgroups based on whether the patients were discharged within 48 hours. One group was day surgery patients who were discharged within 48 hours, and the other group was day surgery patients with delayed discharge, so as to explore the factors affecting the delayed discharge of day surgery.

Results: Compared to the VATS group, the RATS group had a shorter average surgery duration (58.59±12.20 vs. 66.12±21.56 min, P<0.001), less intraoperative blood loss (98.77±51.50 vs. 128.87±65.79 mL, P=0.02), lower total postoperative drainage (185.44±109.14 vs. 268.70±147.99 mL, P=0.007), and a shorter postoperative drainage duration (1.74±0.30 vs. 2.29±0.98 days, P=0.045). The patients experienced less pain, with lower total drug dose of intramuscular diclofenac sodium lidocaine injection and oral celecoxib capsules (111.76±40.52 vs. 167.74±67.20 mg, P<0.001) and reduced pain scores (3.29±0.66 vs. 4.31±0.81, P=0.003). Fewer patients in the RATS group experienced delayed discharges (11 vs. 39, P<0.001), and the incidence of postoperative complications was lower (nausea and vomiting: 3.9% vs. 3.9%, fever: 4.9% vs. 13.5%, pulmonary atelectasis: 0% vs. 2.0%, infection: 1.0% vs. 2.9%, air leakage: 6.9% vs. 8.8%, abnormal drainage fluid: 0% vs. 8.8%, P=0.23; recovery: P=0.27). Meanwhile, subgroup analysis revealed that the four indicators of 24-hour postoperative analgesic medication, operation time, intraoperative bleeding, and tumor history were statistically significant (tumor history: P=0.04; intraoperative bleeding: P=0.005; use of analgesic medication in the 24-hour postoperative period: P=0.001; duration of surgery: P=0.008).

Conclusions: In the surgery setting, RATSs showed better outcomes compared to VATSs, including shorter surgical duration, reduced intraoperative blood loss, lower postoperative drainage volume, shorter drainage duration, and fewer postoperative complications. History of tumor, intraoperative bleeding, use of analgesic medication in the 24-hour postoperative period, and duration of surgery were risk factors for delayed discharge from day surgery.