Clinicopathological features and perioperative outcomes of robot-assisted thoracoscopic surgery for primary lung cancer: An analysis of initial outcomes based on the National Clinical Database

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Abstract
Purpose To analyze the clinicopathological features and perioperative outcomes of patients who underwent robot-assisted thoracoscopic surgery (RATS) for primary lung cancer in the initial period after insurance approval in Japan. Methods The data source was the National Clinical Database, using four annual datasets (2018, 2019, 2020, and 2021) that included information on individuals who underwent lobectomy with lymph-node dissection via robot-assisted thoracoscopic surgery for primary lung cancer. Clinicopathological features and perioperative outcomes by year were analyzed descriptively. Results The median console time was reduced by 22 min from 2018 to 2021 (from 171 min to 149 min, respectively). The median overall operative time was also reduced by 29 min from 2018 to 2021 (from 245 min to 216 min, respectively). The conversion rate from robotic to other approaches was 3.5% in 2018 and 2.4% in 2021, with the frequency decreasing each year. The incidence of postoperative complications ranged from 14.6% to 16.6%, and the 90-day mortality rate ranged from 0.3% to 0.5%, with no remarkable change within the study period. Conclusions The initial perioperative outcomes of RATS for lung cancer in Japan were favorable. Further accumulation of cases and comparative analyses of long-term outcomes with other approaches are expected.

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