Straight Stick and Robotic Resection for Solid Organ Cancer: A US Hospital-Based National Analysis

BACKGROUND: The comparative effectiveness of robotic-assisted versus conventional minimally invasive ("straight stick") approaches across multiple solid organ malignancies remains incompletely defined, limiting evidence-based operative platform selection. STUDY DESIGN: Patients undergoing minimally invasive primary tumor resection for 17 solid organ cancers were identified in the National Cancer Database (2010-2022) and stratified by robotic-assisted versus straight stick approach. The primary endpoint was conversion to open surgery. Secondary endpoints included short-term outcomes and oncologic/technical metrics. Multivariable logistic and negative binomial regression models were used to estimate adjusted associations. RESULTS: Among 2,258,360 patients, 1,339,482 (59.3%) underwent robotic-assisted resection. Robotic surgery was associated with lower adjusted conversion rates compared with straight stick approaches (6.1% vs 13.6%, p<0.001), a finding consistent across all organ sites. Robotic approaches yielded approximately one additional lymph node on average after adjustment. Length of stay, 90-day mortality, and negative margin rates were overall similar between groups, with variation by disease site. CONCLUSIONS: In this large national cohort, robotic-assisted resection for solid organ malignancies was more frequently utilized and associated with lower conversion rates and modestly higher lymph node yield compared with straight stick approaches. These findings support consideration of robotic platforms to reduce conversion risk, although equivalence in other short-term outcomes and potential residual confounding warrant cautious interpretation.