Is Robotic-Assisted Surgery Associated With Receipt of Guideline-Directed Lymph Node Sampling in Wedge Resection for Early-Stage NSCLC?

Background: Recent studies have shown a high-quality wedge resection to be equivalent to lobectomy for small, early-stage non-small cell lung cancer (NSCLC). High-quality wedge resections include compliance with 3+1 lymph node sampling (LNS). We aimed to evaluate whether robotic-assisted wedges are more likely to comply with 3+1 LNS. Methods: The Society of Thoracic Surgeons General Thoracic Database was queried for patients with clinical T1 N0 M0 NSCLC who underwent wedge resection with LNS between July 2021 and January 2023. Multivariable regression was used to examine factors associated with 3+1 LNS. Results: A total of 4162 patients were identified; 1815 (43.6%) underwent 3+1 LNS. Patients in the 3+1 LNS group were less likely to undergo open operations (4.6% vs 6.0%) or video-assisted thoracoscopic surgery (VATS) (40.2% vs 60.8%) ( Conclusions: Less than one-half of patients with early-stage NSCLC who were treated with wedge resection satisfied 3+1 LNS. Patients who underwent robotic-assisted wedge resection were 2.5 times more likely to undergo guideline-concordant LNS. The robotic approach was the most significant factor in achieving 3+1 LNS.