Outcomes of RATS in comparison to VATS and open lung resections for malignancy in propensity matched high-risk patients.

Robotic-assisted thoracoscopic surgery (RATS) is offered to early-stage, low-risk patients. This study compares the outcomes of high-risk malignancy patients who received RATS lung resection with propensity matched similar patients operated via video-assisted thoracoscopic surgery (VATS) and open thoracotomy (OT). All patients discussed at our high-risk meeting who had resections via RATS, VATS or OT between May 2019 and August 2023 were retrospectively investigated. Propensity-matched RATS, VATS and OT groups were created. 145 patients were analysed. The mean age was 71.3 ± 8.4 years and 63 (43.5%) were females. After propensity matching, three groups were created including 31 RATS, 31 VATS, and 31 OT patients. The three groups were similar in baseline characteristics. More segmentectomies were performed via RATS than via VATS or OT (29% vs 9.7% vs 9.7%, respectively, p = 0.009). Length of stay (LOS) and critical care complex CCC-LOS were shorter in the RATS group when compared to VATS or OT (p < 0.001 and p < 0.0001, respectively). Overall and respiratory complications were lower in RATS compared to VATS or OT (35.5% vs 48.4% vs 71%, p = 0.039 and 12.9% vs 38.7% vs 35.5%, p = 0.035, respectively). Unplanned admissions to CCC were lower in the RATS versus the VATS and OT groups (3.2% vs 12.9% vs 22.6%, respectively, p = 0.014). All other variables investigated were similar between groups. Offering RATS lung resections to high-risk patients is a viable surgical option for lung malignancy. The historical consensus to exclude RATS in such patients should be reevaluated as it may confer superior clinical outcomes to other approaches.