To analyze the perioperative and long-term survival outcomes of robotic-assisted thoracoscopic surgery (RATS) in the treatment of patients with non-small cell lung cancer (NSCLC) based on the 13-year clinical practice at Shanghai Chest Hospital.

Consecutive patients with NSCLC who underwent RATS lung surgery at Shanghai Chest Hospital from May 2009 to May 2022 were retrospectively enrolled. Baseline demographic characteristics, perioperative parameters, and long-term survival outcomes were analyzed.

A total of 1 798 patients were included, consisting of 786 males (43.7%) and 1 012 females (56.3%), with a mean age of (59.4±9.1) years. There were 1 557 cases (86.6%) of lobectomy, 112 cases (6.2%) of segmentectomy, and 129 cases (7.2%) of wedge resection. The mean tumor diameter was (2.4±1.1) cm, and adenocarcinoma accounted for the predominant pathological type (90.3%). The mean operative duration was (101.9±28.5) minutes. 80.9% of patients had intraoperative blood loss ≤100 mL, the conversion rate to thoracotomy was 3.8%, and 99.2% of patients achieved negative surgical margins. The mean number of dissected lymph node stations was 5.5±1.6, with a mean of 11.2±5.2 lymph nodes retrieved. The mean postoperative chest tube drainage volume was (710.5±268.3) mL over a mean drainage duration of (3.2±1.8) days, and the mean postoperative hospital stay was (4.5±2.1) days. Postoperative complications occurred in 332 patients (18.5%), among whom 23 cases (1.3%) had severe complications. Survival analysis revealed that the 5-year recurrence-free survival (RFS) rate and overall survival (OS) rate were 82.5% and 88.8%, respectively. Further multivariable Cox regression analyses showed that age, histological subtype, pathological TNM stage, and neoadjuvant therapy were independent prognostic factors for RFS and OS.

RATS is associated with limited intraoperative blood loss, a low conversion rate to thoracotomy, a low postoperative complication rate, and favorable long-term survival outcomes. In our center’s clinical experience, RATS demonstrates favorable perioperative safety profiles and acceptable long-term oncological outcomes, making it a viable surgical approach for NSCLC.