Interstage Interval and Pulmonary Function in Two-Stage RATS for Bilateral Multiple Primary Lung Cancers

Abstract The optimal interstage interval for bilateral multiple primary lung cancers (bMPLCs) remains undefined, particularly in the context of robot-assisted thoracic surgery (RATS). We retrospectively analyzed 24 patients with bMPLCs who underwent planned two-stage RATS at a single institution. Perioperative outcomes were compared between the first and second procedures. Pulmonary function preservation was assessed using the postoperative/preoperative forced expiratory volume in 1 second (FEV1) ratio. The association between interstage interval and FEV1 preservation was evaluated using Spearman correlation and restricted cubic spline (RCS) modeling. Perioperative outcomes were comparable between the two procedures, with no mortality. A significant reduction in FEV1 was observed after the first surgery (p = 0.035). Interstage interval was positively correlated with FEV1 preservation (Spearman's ρ = 0.599, p = 0.002). RCS analysis demonstrated a nonlinear relationship, with a functional recovery threshold at approximately 190 days. Patients with an interval of ≥ 190 days showed significantly better FEV1 preservation than those with < 190 days (0.95 ± 0.12 vs. 0.80 ± 0.09, p = 0.008), and all maintained ≥ 80% of baseline FEV1 (p = 0.004). Two-stage RATS is safe and effective for bMPLCs. An interstage interval of approximately 6 months may optimize pulmonary function recovery, and parenchymal-sparing resection as the initial procedure may be advantageous. These findings suggest a nonlinear, threshold-dependent recovery pattern.