Impact of robotic and non-robotic approach on spread through air spaces in early-stage lung cancer.

Spread through air spaces has been defined by the WHO as a new pattern of invasion in non-small cell lung cancer (NSCLC). The possible role of surgical manipulation in generating this pattern has recently been discussed. The aim of this study is to review the presence of STAS in patients with lung cancer undergoing video-assisted thoracic surgery (VATS) compared to robotic surgery (RATS). 248 resectable stage I-II adenocarcinoma and squamous cell carcinoma who underwent either VATS or RATS between January 2022 and March 2024 were included. We evaluated the association between STAS and the surgical technique, tumour histology and pathological staging. STAS was found in 45 (29%) of the 157 VATS patients and in 14 (15%) of RATS patients. VATS group showed a higher incidence of STAS (p = 0.020). Both groups presented similar proportions in tumor histology and adenocarcinoma grading. In the RATS group, there were significantly more high-grade adenocarcinomas in those with STAS. Based on a multivariable model, the VATS group had twice the chance to show STAS than the RATS group ((OR 2.24 (1.15, 4.59)). Our findings suggest that mechanical tissue manipulation is a factor involved in the occurrence of STAS. Robotic surgery is associated with a lower rate of STAS in early-stage adenocarcinoma and squamous cell carcinoma.