Assessment of Modified Textbook Outcome Achievement after Dual-Port versus Multi-Port Robotic Anatomical Lung Resection: A Propensity-Matched Observational Study

Background: Reduced-port robotic thoracic surgery is intended to reduce access-related trauma while preserving procedural quality. This study compared dual-port and conventional multi-port robotic anatomical lung resection using modified Textbook Outcome (TO) achievement as a composite perioperative quality metric. Methods: Consecutive patients who underwent robotic-assisted lobectomy or segmentectomy for lung cancer or metastatic lung tumors between January 2022 and December 2024 were retrospectively reviewed. Dual-port robotic-assisted thoracic surgery (D-RATS) was compared with multi-port robotic-assisted thoracic surgery (M-RATS). The primary endpoint was modified TO achievement, defined using 9 perioperative criteria. One-to-one propensity-score matching was performed using preoperative variables, including demographics, pulmonary function, comorbidity burden, tumor size, and procedure type. Results: Among 171 eligible patients, including 88 who underwent D-RATS and 83 who underwent M-RATS, propensity-score matching yielded 61 well-balanced pairs. In the matched cohort, modified TO was achieved in 42/61 patients (68.8%) in the D-RATS group and 41/61 patients (67.2%) in the M-RATS group (absolute difference, 1.6%; matched odds ratio, 1.07; 95% confidence interval, 0.49-2.36; p=0.85). Median operative time (151 minutes vs. 162 minutes, p=0.16) and median blood loss (10 mL vs. 10 mL, p=0.72) were similar between groups. Median chest drain duration was 1 day in both groups, but the distribution was narrower in the D-RATS group (1 [interquartile range, 1-1] days vs. 1 [interquartile range, 1-2] days, p=0.001). Conclusion: In this propensity-matched cohort, D-RATS maintained perioperative quality comparable to that of conventional M-RATS when assessed using modified TO achievement, without compromising procedural efficiency.