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Page 2 of 8 Ricciardi et al. Mini-invasive Surg 2020;4:1 I http://dx.doi.org/10.20517/2574-1225.2019.50

to the technical and technological improvements achieved during the decades, the surgical approach
has moved from open procedures to minimally invasive surgery (MIS). MIS [including video-assisted
thoracic surgery (VATS) and robot-assisted surgery] has become the preferred approach in patients with
no contraindications (anatomic or surgical), given that the less invasive approach does not compromise the
[2]
oncologic cancer outcomes and is associated with better short-term results compared to thoracotomy .

Regardless of the approach, the oncologic principles remain unchanged: the achievement of negative
margins (R0 resection) and a systematic lymph node dissection; the open approach for lobectomy remains
the cornerstone with which the results of the other techniques are compared.

Recent data have reported an important increase in VATS and robotic lobectomy versus open procedures
and several studies have shown that MIS lobectomy results in comparable oncologic outcomes to those of
[3,4]
open approach . However, Level 1 evidence does not exist and data on long-term outcomes for NSCLC
[5]
patients treated with robotic approach are still lacking .
The aim of this review is to analyse the literature concerning the long-term survival of robotic lung lobectomy.

METHODS
A literature review was conducted by searching PubMed in July 2019, using the search terms: (“lung cancer”
OR “lung tumour” OR “lung neoplasm” OR “NSCLC”) AND (“robotic” OR “robot assisted” OR “da Vinci”
OR “daVinci”) AND [“analysis, survival” (MESH TERMS)].

Inclusion criteria were: (1) the paper described robotic-assisted lobectomy; and (2) the study was a
randomised controlled trial, meta-analysis or single centre/multicentre database study recording on robotic
lobectomy.

Exclusion criteria were: (1) the study did not provide results for the long-term outcomes of robotic lobectomy;
(2) the study focused on results of sub-lobar resections; and (3) the study included fewer than 50 cases.

After language restriction (English), applying inclusion and exclusion criteria and eliminating duplicate
papers, ten studies were selected for this analysis, all reporting robotic lung lobectomy for NSCLC [Figure 1].

RESULTS
Six retrospective, observational single centre studies, three retrospective multicentre studies and one
prospective cohort study published between 2008 and January 2019 were included in this analysis [Table 1]. In
total, 2873 patients, with a mean age ranging between 66 and 68 years, who underwent robotic lobectomy
for NSCLC, were analysed.

The majority of patients (81%) had early-stage disease [1892 stage I (66%), 443 stage II (15%)] and only a few
of them had advanced or metastatic disease [507 stage III (18%), 31 stage IV (1%)].

Short-term outcomes
The mean length of stay reported was 4.5 days (ranging between 3 and 8 days), the mean conversion rate
was 8.4% (ranging between 0% and 9.8%) and the mean post-operative 30-day mortality was 0.25% (ranging
between 0% and 4.9%).

The mean rates of reported overall complications and major complications were 25.4% (ranging between
9.52% and 66.4%) and 5.85% (ranging between 2.4% and 10.3%), respectively [Table 1].