[The Results of RATS and VATS Anatomical Resections in the Initial Phase].

Abstract

Robot-assisted (RATS) anatomical resection is a new method in the treatment of lung tumours, but is controversial due to its cost. The aim of our retrospective study was to compare the clinical results of the RATS and VATS anatomical resections.The first 100 VATS and RATS resections were analysed with regard to tumour stage, intra- and postoperative complications, conversion, operation time, hospital stay and length of drainage treatment, postoperative pain (numerical rating scale, NRS) and mortality. The results were compared using the chi-square, Fisher and independent t tests.In the VATS group, stage I was more frequent, stage II less frequent (stage I: 73.4%, stage II: 19.2%) than in the RATS group (stage I: 65.5%, stage II. 23%, p = 0.695). The operating time was longer with RATS (213.5 min vs. 190.3 min, p = 0.008), due to the docking and undocking time of the robotic system to the patient. The proportion of sublobar resections was significantly higher in the RATS group (28% vs. 7%, p < 0.001). The proportion of intraoperative complications (7% vs. 14%, p = 0.073) and conversion rate (9% vs. 11%, p = 0.407) were lower in the RATS surgery. The number of lymph nodes removed was high in both groups and not significantly different (VATS: 21.6, RATS: 22.1). The hospital stay was shorter after RATS (8.8 days) than after VATS (12.5 days, p < 0.001), as was the length of postoperative drainage treatment (5.6 vs. 8 days, p < 0.001). In the RATS group, postoperative pain on the 1st and 2nd postoperative day was significantly lower, as based on the numeric rating scale (1.68 vs. 2.83, p < 0.001, 0.99 vs. 2.41, p < 0.001). The complication rate was significantly higher after VATS than after RATS (57% vs. 33%, p = 0.001), and fewer reoperations were necessary after RATS (3%) than in the VATS group (8%, p = 0.121). Four patients died in the VATS group, none after RATS (p = 0.043).The robot-assisted technique enables anatomical resections with lower conversion, complication rates and mortality, as well as less postoperative pain. Robotic surgery has proven to be safe and oncologically comparable to anatomical VATS resections for lung cancer.