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Robotic Versus Video-assisted Lobectomy/Segmentectomy for Lung Cancer: A Meta-analysis

Liang, Hengrui, MD*,†; Liang, Wenhua, MD*; Zhao, Lei, PhD; Chen, Difei, MD*,†; Zhang, Jianrong, MD*; Zhang, Yiyin, MD*,†; Tang, Shiyan, MD*,†; He, Jianxing, MD*,†

doi: 10.1097/SLA.0000000000002346

Objective: To compare the safety/efficacy of the robotic-assisted lobectomy/segmentectomy (RAL/S) with the video-assisted lobectomy/segmentectomy (VAL/S) for radical lung cancer resection.

Background: It remains uncertain whether the newly developed RAL/S is comparable with the VAL/S.

Methods: A comprehensive search of online databases was performed. Perioperative outcomes were synthesized. Cumulative meta-analysis was performed to evaluate the temporal trend of pooled outcomes. Specific subgroups (propensity score matching studies, pure lobectomy studies) were examined.

Results: Analysis of 14 studies including a total of 7438 patients was performed. RAL/S was performed on 3239 patients, whereas the other 4199 patients underwent VAL/S. The 30-day mortality [0.7% vs 1.1%; odds ratio (OR) 0.53, P = 0.045] and conversion rate to open surgery (10.3% vs 11.9%; OR 0.57, P < 0.001) were significantly lower in patients who underwent RAL/S than VAL/S. Meanwhile, the postoperative complications (27.5% vs 28.2%; OR 0.95, P = 0.431), operation time [176.63 vs 162.74 min; standardized mean difference (SMD) 0.30, P = 0.086], duration of hospitalization (4.90 vs 5.23 days; SMD −0.08, P = 0.292), days to tube removal (4.10 vs 3.53 days; SMD 0.25, P = 0.120), retrieved lymph node (11.96 vs 10.67; SMD 0.46, P = 0.381), and retrieved lymph node station (4.98 vs 4.32; SMD 0.83, P = 0.261) were similar between the 2 groups. The cumulative meta-analyses suggested that the relative effects between 2 groups have already stabilized. All outcomes of subgroup and overall analyses were similar.

Conclusions: This up-to-date meta-analysis confirms that RAL/S is a feasible and safe alternative to VAL/S for radical resection of lung cancer. Future studies should focus on the long-term benefits and cost effectiveness of RAL/S compared with VAL/S.

*Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, China

Nanshan School, Guangzhou Medical University, Guangzhou, China

The Sixth Affiliated Hospital, School of Basic Medical Sciences, Functional Experiment Center, Guangzhou Medical University, Guangzhou, China.

Reprints: Jianxing He, MD, Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China/State Key Laboratory of Respiratory Diseases, Guangzhou, China/National Clinical Research Center for Respiratory Center for Respiratory Disease, Guangzhou, China. E-mail:

Author contributions: All authors were involved in the conception and design of the study. H-R.L., W.-H.L., and D.-F.C. contributed to the data acquisition. Y.-Y.Z., S.-Y.Z., J.-R.Z., L.Z., and J.-X.H. contributed to the analysis and writing of the manuscript. All authors critically reviewed and approved the final manuscript.

Funding: This work was supported by the following funding: Science and Technology Planning Project of Guangdong Province, China (Grant numbers: 2007B031515017; 2008A030201024); Science and Technology Planning Project of Guangzhou, China (Grant numbers: 2007Z1-E0111; 2007Z3-E0261); Guangzhou Health and Medical Collaborative Innovative Major Special Projects (Grant No. 201400000001–2).

The authors report no conflicts of interest.

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