Does Robotic Segmentectomy Improve Long-Term Outcomes in Non-Small Cell Lung Cancer?

Objectives: Lung cancer remains the leading cause of cancer-related death globally. While lobectomy is the standard treatment for early-stage disease, trials have shown that segmentectomy offers comparable survival outcomes for small (≤2 cm) peripheral tumours. Robotic-assisted thoracic surgery (RATS) has gained popularity due to enhanced precision compared with video-assisted thoracic surgery (VATS). However, comparative outcomes of RATS vs VATS segmentectomy remain unclear. This study, therefore, aimed to compare short-term and long-term outcomes in patients undergoing VATS and RATS segmentectomy for non-small cell lung cancer (NSCLC). Methods: We retrospectively reviewed consecutive patients undergoing RATS or VATS segmentectomy for NSCLC between July 2015 and December 2021. Primary outcomes were overall survival (OS), disease-free survival (DFS), and recurrence. Secondary outcomes included complications, length of stay, length of drainage, and lymph-node stations harvested. Results: A total of 144 patients were included (RATS n = 86; VATS n = 58). Baseline characteristics were comparable across groups. RATS was associated with a significantly greater number of lymph-node stations harvested and wider tumour-free margins. Short-term outcomes, including complications, length of stay, drainage duration, conversion rates, and operative time, were similar. Long-term outcomes favoured the robotic approach, with significantly improved OS, DFS, and lower recurrence rates, although multivariable analysis showed no significant difference in hazard ratios between approaches. Conclusions: RATS segmentectomy demonstrated improved survival metrics and reduced recurrence compared with VATS while maintaining comparable perioperative outcomes. The robotic platform facilitated more extensive lymphadenectomy and wider resection margins, which may underlie the observed oncologic advantages.