Short-term postoperative complications of robot-assisted thoracoscopic resections for lung cancer

Background: The robotic platform for pulmonary resection is an increasingly utilized approach in minimally invasive thoracic surgery. Short-term outcomes following robotic resections remain underreported. This study evaluates early postoperative complications in lung cancer patients undergoing robot-assisted lobectomies, segmentectomies, and wedge resections.

Methods: We conducted a retrospective cohort study of patients who underwent a robot-assisted lobectomy, segmentectomy, or wedge resection from September 2015 to December 2024 at a multicenter health system in the United States. Demographics, comorbidities, and complications during the first postoperative month were analyzed. Outcomes were compared using Chi-squared, Fisher’s exact, or Kruskal-Wallis test as appropriate based on the type and distribution of the variables. Univariate and multiple logistic regression models were used to identify factors associated with major complications.

Results: A total of 1,438 lung cancer patients were included for analysis, of which there were 861 lobectomies (60%), 179 segmentectomies (12%), and 398 wedge resections (28%). 73.1% of patients were of Asian descent. Lobectomies had higher rates of readmission than segmentectomies and wedge resections (2.0% vs. 0.0% vs. 0.3%, respectively; P=0.01), and longer median hospital stays (3 days) compared to sublobar groups (2 days each; P<0.001). The most common complication was a prolonged air leak, affecting 12.2% of lobectomies, 3.9% of segmentectomies, and 5.3% of wedge resections (P<0.001). Lobectomies experienced the highest rate of major complications (9.1%), followed by wedge resections (3.8%), and segmentectomies (1.7%; P<0.001). This did not impact patient mortality, with one mortality observed in each procedure group (P=0.22). After adjustment, segmentectomies had reduced odds of complications compared to wedge resections, though this did not reach statistical significance [odds ratio (OR) =0.28; 95% confidence interval (CI): 0.06–1.26; P=0.10]. Female sex (OR =0.59; 95% CI: 0.37–0.93; P=0.02), preoperative diffusing capacity for carbon dioxide (OR =0.98; 95% CI: 0.97–0.99; P<0.001), conversion to open (OR =2.9; 95% CI: 1.01–8.30; P=0.048), and lobectomies (OR =2.76; 95% CI: 1.52–5.03; P<0.001) independently predicted major complications.

Conclusions: Robotic lobectomy is associated with a higher incidence of early postoperative complications compared to segmentectomies and wedge resections, but remains a safe and viable option, with no increased risks of life-threatening complications or mortality.