Comparing Short Outcomes of Robotic-Assisted vs. Video-Assisted Thoracoscopic Surgery for Lobectomy in Non-Small Cell Lung Cancer in Asia: A Systematic Review and Meta-Analysis

Background: Open surgery remains a therapeutic option for early-stage non-small cell lung cancer (NSCLC), though it is commonly associated with higher complication rates and prolonged hospitalization. Minimally invasive techniques such as robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) have emerged as widely accepted alternatives for lobectomy. However, comparative analysis is needed to evaluate their relative clinical effectiveness. Methods: This systematic review and meta-analysis included studies published between January 2014 and September 2024, retrieved from PubMed, ScienceDirect, and Cochrane databases. A total of 927 records were screened, and five studies met the inclusion criteria, focusing on short-term outcomes of RATS versus VATS for lobectomy in NSCLC patients across Asia. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool, and all procedures followed PRISMA and Cochrane Handbook guidelines. Statistical analysis was performed using Review Manager (RevMan) version 5.4.1. Results: Five studies comprising 1,091 patients (404 RATS; 687 VATS) were included. RATS showed a shorter hospital stay (SMD = -0.53; 95% CI: -0.93 to -0.14; I² = 88%; p = 0.008) and chest tube duration (SMD = -0.35; 95% CI: -0.65 to -0.04; I² = 80%; p = 0.03). No significant differences were observed in operative time or number of dissected lymph nodes. Conclusion: RATS may offer clinical benefits in reducing hospitalization and chest tube duration, while maintaining comparable outcomes to VATS in operative time and lymphadenectomy.