This study compares long-term outcomes in patients undergoing video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) lobectomy for non-small cell lung cancer (NSCLC); all consecutive patients who underwent RATS or VATS lobectomy for NSCLC between July 2015 and December 2021 in our center were enrolled in a single-center prospective study. The primary outcomes were overall survival (OS), disease-free survival (DFS), and recurrence rate. The secondary outcomes were complication rate, length of hospitalization (LOS), duration of chest tubes (LOD), and number of lymph node stations harvested. A total of 619 patients treated with RATS (n = 403) or VATS (n = 216) were included in the study. There was no significant difference in OS between the RATS and VATS groups (3-year OS: 75.9% vs. 82.3%; 5-year OS: 70.5% vs. 68.5%; p = 0.637). There was a statistically significant difference in DFS between the RATS and VATS groups (3-year DFS: 92.4% vs. 81.2%; 5-year DFS: 90.3% vs. 77.6%; p < 0.001). Subgroup analysis according to the pathological stage also demonstrated a significant difference between RATS and VATS groups in DFS in stage I (3-year DFS: 94.4% vs. 88.9%; 5-year DFS: 91.8% vs. 85.2%; p = 0.037) and stage III disease (3-year DFS: 82.4% vs. 51.1%; 5-year DFS: 82.4% vs. 37.7%; p = 0.024). Moreover, in multivariable Cox regression analysis, the surgical approach was significantly associated with DFS, with an HR of 0.46 (95% CI 0.27–0.78, p = 0.004) for RATS compared to VATS. VATS lobectomy was associated with a significantly higher recurrence rate compared to RATS (21.8% vs. 6.2%; p < 0.001). LOS and LOD, as well as complication rate and in-hospital and 30-day mortality, were similar among the groups. RATS lobectomy was associated with a higher number of lymph node stations harvested compared to VATS (7 [IQR:2] vs. 5 [IQR:2]; p < 0.001). In conclusion, in our series, RATS lobectomy for lung cancer led to a significantly higher DFS and significantly lower recurrence rate compared to the VATS approach. RATS may allow more extensive nodal dissection, and this could translate into reduced recurrence.

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.

Background: In the past years, segmentectomy has been increasingly used to remove small peripheral lung cancers; however, segmentectomies seem to be associated with an increased incidence of prolonged air-leaks compared to lobectomies. Over the years, numerous air sealants were tested, but the most effective of all appears to be Progel^TM Platinum. Although this sealant has been proved to be effective in reducing post-operative air-leaks in lobectomies, there are still little data about its efficacy in segmentectomies. Our aim is to evaluate the safety and effectiveness of Progel^TM Platinum for intraoperative closure of air leaks during pulmonary segmentectomy. Methods: Retrospective comparative cohort study of consecutive patients undergone anatomical segmentectomy at two high-volume centres between January 2018 and September 2022. Patients were divided in two groups according to whether the sealant was used. The sealant was applied intraoperatively to the remaining lung. Prolonged air leak (PAL) was defined as lasting more than 5 days. Results: One hundred and eighty-one patients were included in the study: 90 patients in the sealant group (SG) and 91 in the control group (CG). PAL was observed in 5.5% (n=5) of patients in the SG compared to 12.1% (n=11) in the CG (P=0.19). In the CG, there was a significant difference in the rate of PAL following a simple and complex segmentectomy (2.8% vs. 18.2%; P=0.03), while in the SG, the rate of PAL did not differ between the two (6.1% vs. 5.3%; P=0.87). The mean duration of chest tubes was significantly lower in the SG compared to the CG vs. 3.8±4.8 days, P=0.02). The mean length of hospitalization was 4±2.8 days in the SG vs. 7±5.0 days in the CG (P<0.001). The sealant was not associated with any adverse events. Conclusions: The sealant was safe and effective for intraoperative closure of air leaks following segmentectomy. Use of the sealant decreased the rate of PALs and it led to a significant reduction in chest tube duration and length of hospitalization.