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Page 6 of 8 Ricciardi et al. Mini-invasive Surg 2020;4:1 I http://dx.doi.org/10.20517/2574-1225.2019.50

Table 3. Stage specific overall survival according to the eighth edition of TNM
Stage Two-year survival Five-year survival
IA1 97% 92%
IA2 94% 83%
IA3 90% 77%
IB 87% 68%
IIA 79% 60%
IIB 72% 53%
IIIA 55% 36%
IIIB 44% 26%
IIIC 24% 13%
IVA 23% 10%
IVB 10% 0%

rate in patients who underwent surgery after induction therapies (15% vs. 9.9%); however, this study showed
[14]
the feasibility and safety of robotic approach even after neoadjuvant chemo-radiotherapy .
The 30-day mortality rate of the entire population examined in this review is 0.25% (range 0%-4.9%).
[19]
According to a recent meta-analysis conducted by O’Sullivan et al. , the mortality rate is lower for patients
who underwent robotic surgery compared to VATS or Open approaches with an overall protective effect of
robotic over thoracotomy [OR: 0.53, 95%CI: 0.33-0.85 (P = 0.008)] and over VATS [OR: 0.61, 95%CI: 0.45-
0.83 (P < 0.001)]. Notwithstanding these results should be thoughtfully considered, given that a possible
selection bias in robotic cohort may have occurred, data on short-term outcomes of robotic surgery are
very interesting.

Analysing the long-term results, the overall and stage-specific survival of robotic lobectomy are consistent
[20]
with data reported by Goldstraw et al. , which were mainly obtained by open surgery [Table 3].
[15]
According to the largest multicentre series of robotic lobectomy analyses by Cerfolio et al. , which also
included many other examined cohorts, the OS of patients who had completely resected NSCLC via robotic
lobectomy is favourable compared to open surgery. One possible explanation proposed by the authors is a
reduction of immunocompromised state after MIS surgery.

Moreover, the authors stated that DFS of robotic cohort is promising, especially in case of N2 disease. This
is probably due to the easier and more precise dissection of lymph node during robotic surgery, which also
leads to superior upstaging compared to VATS, improved staging and greater chance to undergo adjuvant
[21]
chemotherapy .

Our review reports good short- and long-term outcomes after robotic lobectomy for NSCLC, which
combines the benefits of MIS with the accuracy of open surgery in stage-assessment, showing an overall
and stage-specific OS comparable with that reported by IASLC database.

DECLARATIONS
Acknowledgments
The Authors thank Teresa Hung Key for linguistic accuracy checking.

Authors’ contributions
Conception and design, collection and assembly of data, data analysis and interpretation: Ricciardi S
Administrative support: Melfi FMA, Davini F
Provision of study materials or patients: Davini F, Romano G, Zirafa CC