Increased Opioid Consumption and Complication Rates in Robot-Assisted Versus Uniportal Video-Assisted Thoracoscopic Surgery for Non-Small Cell Lung Cancer

P0175 

Abstract Submission 

Xing Wei (1), Rumei Xiang (2), Wei Dai (1), Ding Yang (3), Hongfan Yu (4), Lin Huang (5), Yangjun Liu (6), Kunpeng Zhang (7), Qiuling Shi (2), Qiang Li (1)

(1) Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, (2) School of Public Health, Chongqing Medical University, Chongqing, Chongqing, (3) Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, (4) College of Biomedical Engineering, Chongqing Medical University, Chongqing, Chongqing, (5) Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, (6) Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, (7) Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, Shanghai

Xing Wei    -  Contact Me
Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute

Rumei Xiang    -  Contact Me
School of Public Health, Chongqing Medical University

Wei Dai    -  Contact Me
Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute

Ding Yang    -  Contact Me
Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University

Hongfan Yu    -  Contact Me
College of Biomedical Engineering, Chongqing Medical University

Lin Huang    -  Contact Me
Department of Cardiothoracic Surgery, Copenhagen University Hospital

Yangjun Liu    -  Contact Me
Department of Medical Epidemiology and Biostatistics, Karolinska Institute

Kunpeng Zhang    -  Contact Me
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine

Qiuling Shi    -  Contact Me
School of Public Health, Chongqing Medical University

Qiang Li    -  Contact Me
Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute

Xing Wei    -  Contact Me
Sichuan Cancer Hospital & Institute

Objective: To compare intraoperative and postoperative opioid consumption, as well as clinical outcomes, between robot-assisted thoracoscopic surgery (RATS) and uniportal video-assisted thoracoscopic surgery (U-VATS) in patients undergoing pulmonary resection for non-small cell lung cancer (NSCLC). Methods: We conducted a retrospective analysis at a cancer specialty hospital using data extracted from the CN-PRO-Lung3, an ongoing longitudinal prospective cohort study. For our analysis, we included patients from CN-PRO-Lung3 who were enrolled between April 2021 and November 2022 and met our study criteria. The inclusion criteria were: patients who underwent RATS or U-VATS; had postoperative pathology confirming primary lung cancer; and received sublobar resection, lobectomy, or extended resection surgery. The exclusion criteria were: patients who had secondary surgeries; had non-specific resection types; or had received preoperative neoadjuvant therapy. The primary outcome was opioid usage, measured intraoperatively and postoperatively using oral morphine equivalents (OME). Secondary outcomes included various perioperative clinical outcomes. Baseline characteristics and postoperative outcomes were compared between the RATS and U-VATS groups using appropriate statistical tests such as the Mann-Whitney U test, chi-square test, and Fisher's exact test. Results: After identifying 1,737 patients from the cohort, a total of 1,057 patients were included in the analysis. RATS was associated with a higher frequency of lobectomy (57.51% vs. 40.39%, p < 0.001) and systematic lymph node dissection (56.48% vs. 23.84%, p < 0.001). Intraoperatively, RATS patients received a higher total OME (median 94.2 mg vs. 84.9 mg, p = 0.003). Postoperatively, 89.12% of RATS patients received opioids compared to 56.94% of U-VATS patients (p < 0.001), with RATS patients also receiving a higher total OME postoperatively (median 48 mg vs. 42 mg, p < 0.001). Additionally, RATS was associated with higher rates of perioperative complications classified as Clavien-Dindo grade ≥2 (13.47% vs. 4.98%, p < 0.001). Conclusions: RATS is associated with increased intraoperative and postoperative opioid consumption and higher rates of significant perioperative complications compared to U-VATS. These findings suggest that while RATS may offer certain surgical advantages, it may also entail greater analgesic needs and a higher risk of complications.

Lung Cancer