Comparison of Early Postoperative Patient-Reported Outcomes after Multiportal Robotic-Assisted Thoracoscopic Surgery and Uniportal Video-Assisted Thoracoscopic Surgery for Non-Small Cell Lung Cancer

Introduction We aimed to compare early postoperative patient-reported outcomes between multiportal robotic-assisted thoracoscopic surgery (M-RATS) and uniportal video-assisted thoracoscopic surgery (U-VATS) for non-small-cell lung cancer (NSCLC). Materials and methods Symptom severity and functional status were measured using the Perioperative Symptom Assessment for Lung Surgery at pre-surgery, during postoperative hospitalisation, and within 4 weeks of discharge. A propensity score-matched (PSM) analysis of patients with NSCLC who were treated with M-RATS and U-VATS was performed. The symptom severity and daily functional status presented as proportion of moderate-to-severe scores on a 0-10-point scale, were compared using a generalised estimation equation model. Results We enrolled 762 patients with NSCLC from a prospective cohort (CN-PRO-Lung 3), including 151 and 611 who underwent M-RATS and U-VATS, respectively, before PSM analysis. After 1:1 PSM, two groups of 148 patients each were created. Pain severity (P=0.019) and activity limitation (P=0.001) during hospitalisation were higher in the M-RATS group. However, no significant differences existed post-discharge in pain (P=0.38), cough (P=0.68), shortness of breath (P=0.53), disturbed sleep (P=0.53), drowsiness (P=0.15), fatigue (P=0.30), distress (P=0.89), walking difficulty (P=0.24), or activity limitation (P=0.51). M-RATS caused less intraoperative blood loss (P=0.013), more stations of dissected lymph nodes (P=0.001), more numbers of dissected lymph nodes (P=0.001), and less tube drainage on the first postoperative day (P=0.003) than U-VATS. Conclusion M-RATS and U-VATS achieved comparable symptom burden and functional impairment after discharge. However, compared to U-VATS, M-RATS was associated with more severe pain and activity limitation in the short postoperative period. Trial registration number ChiCTR2000033016