The uptake of segmentectomy for non-small cell lung cancer in adopters of robotic surgery.

Objective: Segmentectomy has been shown to be comparable with lobectomy for small lung cancers; however, it is unclear the degree to which the expansion and adoption of robotics have affected the use of segmentectomy. We aim to compare the use of segmentectomies performed between adopters and nonadopters of robotic surgery. Methods: A retrospective case-control analysis was conducted using the National Cancer Database from 2010 to 2021. Sustained robotic adoption was defined as facility performance of ≥90% of lung resections robotically for 2+ consecutive years from 2016 onwards. Time periods for facilities were categorized by pretransition (<50% usage), transition (50%-90%) and posttransition (≥90%). For all facilities, the proportion of segmentectomies performed for <2 cm lung nodules was quantified along with clinical outcomes. Results: In total, 10,045 cases of lung resection across 57 facilities met inclusion criteria. National use of segmentectomy increased from 5% in 2011 to 12% in 2019-2021. The proportion of segmentectomies performed for nodules meeting criteria has increased more with sustained robotic adopters (5.5% to 12.0%) compared with control facilities (4.0% to 6.3%) (difference-in-difference = 4.3%; 95% CI, 2.6%-6.0%). There was an increase in mean lymph node harvest for segmentectomy with sustained adopters (5.1 to 11.4) compared with control facilities (6.02 vs 10.2). Conclusions: Facilities with sustained robotic adoption were more likely to have increased uptake of segmentectomy compared with control facilities. There was also an associated increase in mean lymph node sampling. With continued uptake of robotics, we expect to see greater use of segmentectomy for lung resection for nodules meeting criteria.