Short-term perioperative outcomes of multi-arm uniportal robotic-assisted versus uniportal video-assisted thoracoscopic segmentectomy for stage IA NSCLC: a propensity score-matched study.

Robot-assisted thoracoscopic surgery has emerged as a new option for lung cancer surgery. This study aimed to compare the short-term perioperative outcomes of Multi-Arm Uniportal Robotic-Assisted Thoracic Surgery (M-URATS) and uniportal video-assisted thoracoscopic surgery (UVATS) in patients undergoing segmentectomy for stage IA non-small cell lung cancer. Clinical data of 179 patients who underwent M-URATS or Uniportal video-assisted thoracoscopic surgery (UVATS) segmentectomy and were pathologically confirmed as non-small cell lung cancer (NSCLC) were retrospectively reviewed. Propensity scores were estimated using available baseline clinicopathological variables, and 1:1 optimal propensity score matching without replacement was performed within exact T-stage strata to reduce baseline imbalance. A total of 170 patients (65 M-URATS, 105 UVATS) were enrolled according to the exclusion criteria. After propensity score matching, 46 patients remained in each group. After matching, compared with the UVATS group, the M-URATS group had a greater recorded number of assessed nodal stations and retrieved lymph nodes. The M-URATS group also showed more favorable short-term perioperative outcomes, including shorter operative time, less intraoperative blood loss, shorter drainage duration, lower drainage volume, and shorter postoperative length of stay after matching. No significant differences were observed in postoperative white blood cell change, hemoglobin change, albumin change, conversion to open surgery, or postoperative complications; however, the matched cohort was limited in size and was underpowered for uncommon safety outcomes. In addition, the total hospitalization cost remained higher in the M-URATS group than in the UVATS group (9560 ± 1310 USD vs. 7280 ± 1040 USD, P < 0.001). M-URATS appears to be a feasible option for selected patients undergoing segmentectomy for stage IA NSCLC and may be associated with more favorable short-term perioperative outcomes, particularly in recorded nodal assessment, blood loss control, chest drainage, and early postoperative recovery. UVATS remains a mature clinical alternative, and surgical approach should be individualized according to patient, tumor, anatomical, institutional, and economic factors. The findings should not be interpreted as evidence of safety equivalence, pain superiority, or long-term oncologic superiority.