Authors: D. Adamica 1,2; L. Tulinský 1,2; J. Hrubovčák 1,2; M. Mitták 1,2; L. Martínek 1,2 Authors‘ workplace: Chirurgická klinika, LF OU a FN Ostrava 1; Katedra chirurgických, studií, LF OU 2 Published in: Rozhl. Chir., 2025, roč. 104, č. 12, s. 526-532. Category: Review doi: https://doi.org/10.48095/ccrvch2025526
Mediastinal lymphadenectomy plays a crucial role in the surgical treatment of non-small cell lung cancer (NSCLC), as accurate staging significantly influences subsequent therapy. Robot-assisted thoracoscopic surgery (RATS) has emerged over the past decade as an advanced minimally invasive approach with the potential to achieve high oncological radicality. This review explores the outcomes of mediastinal lymphadenectomy performed using the RATS technique and compares them with those of video-assisted thoracoscopic surgery (VATS). In most studies, a higher, at least comparable, total number of lymph nodes was retrieved with RATS compared to VATS. The number of dissected nodal stations was comparable between RATS and VATS in most studies. Authors frequently highlight the advantages of robotic technology, including enhanced visualization, precise dissection, and the potential to detect occult nodal metastases. The technique is also associated with low morbidity and a feasible learning curve. Although robust long-term survival data are still lacking, current findings suggest that RATS may represent a safe and effective option for mediastinal lymphadenectomy in NSCLC, particularly in centres with established robotic programs.
VATS – Rats – robot-assisted surgery – NSCLC – mediastinal lymphadenectomy
1. Haruki T, Takagi Y, Kubouchi Y et al. Comparison between robot-assisted thoracoscopic surgery and video-assisted thoracoscopic surgery for mediastinal and hilar lymph node dissection in lung cancer surgery. Interact Cardiovasc Thorac Surg 2021; 33(3): 409–417. doi: 10.1093/icvts/ivab112.
2. Wang Y, Darling GE. Complete mediastinal lymph node dissection versus systematic lymph node sampling in surgical treatment of non-small cell lung cancer: do we have the answer? J Thorac Dis 2017; 9(11): 4169–4170. doi: 10.21037/jtd.2017.10.39.
3. Koulaxouzidis G, Karagkiouzis G, Konstantinou M et al. Sampling versus systematic full lymphatic dissection in surgical treatment of non-small cell lung cancer. Oncol Rev 2013; 7(1): e2. doi: 10.4081/oncol.2013.e2.
4. Thomas PA. Lymph node dissection during sublobar resection: why, when and how? J Thorac Dis 2018; 10(S10): S1145–S1150. doi: 10.21037/jtd.2018.01.30.
5. Vallières E, Shepherd FA, Crowley J et al. The IASLC lung cancer staging project: proposals regarding the relevance of TNM in the pathologic staging of small cell lung cancer in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol 2009; 4(9): 1049–1059. doi: 10.1097/JTO.0b013e3181b27799.
6. Aprile V, Ceccarelli I, Stylianos K et al. A narrative review on lymphadenectomy: from open to minimally invasive surgery. Videoassist Thorac Surg 2021; 7 : 6. doi: 10.21037/vats-21-33.
7. Tulinský L, Kepičová M, Ihnát P et al. Radicality and safety of mediastinal lymphadenectomy in lung resection: a comparative analysis of uniportal thoracoscopic, multiportal thoracoscopic, and thoracotomy approaches. Surg Endosc 2023; 37(12): 9208–9216. doi: 10.33699/PIS.2024.103.2.48-56.
8. Ettinger DS, Kris MG. Update: NCCN non-small cell lung cancer clinical practice guidelines. J Natl Compr Canc Netw 2004; 2(Suppl 3): S9–S13.
9. Zer A, Ahn MJ, Barlesi F et al. Early and locally advanced non-small-cell lung cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2025; 36(11): 1245–1262. doi: 10.1016/j.annonc.2025.08.003.
10. Lardinois D, Deleyn P, Vanschil P et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg 2006; 30(5): 787–792. doi: 10.1016/j.ejcts.2006.08.008.
11. Cardillo G, Horsleben-Petersen R. European guidelines for the surgical management of pure ground-glass opacities and part-solid nodules: task force of the European Association of Cardio-Thoracic Surgery and the European Society of Thoracic Surgeons. Eur J Cardiothorac Surg 2023; 64(4): ezad222. doi: 10.1093/ejcts/ezad222.
12. Ureña A, Moreno C, Macia I et al. A comparison of total thoracoscopic and robotic surgery for lung cancer lymphadenectomy. Cancers 2023; 15(13): 3442. doi: 10.3390/cancers15133442.
13. Ramadan OI, Wei B, Cerfolio RJ. Robotic surgery for lung resections – total port approach: advantages and disadvantages. J Vis Surg 2017; 3 : 22. doi: 10.21037/jovs.2017.01.06.
14. Miyajima M, Maki R, Arai W et al. Robot-assisted vs. video-assisted thoracoscopic surgery in lung cancer. J Thorac Dis 2022; 14(6): 1890–1899. doi: 10.21037/jtd-21-1696.
15. Page MJ, McKenzie JE, Bossuyt PM et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71. doi: 10.1136/bmj.n71.
16. Cerfolio RJ, Ghanim A, Dylewski M et al. The long-term survival of robotic lobectomy for non-small cell lung cancer: a multi-institutional study. J Thorac Cardiovasc Surg 2018; 155(2): 778–786. doi: 10.1016/j.jtcvs.2017.09.016.
17. Casiraghi M, Cara A, Mazzella A et al. 1000 robotic-assisted lobectomies for primary lung cancer: 16 years single center experience. Lung Cancer 2024; 195 : 107903. doi: 10.1016/j.lungcan.2024.107903.
18. Casiraghi M, Galetta D, Borri A et al. Ten years’ experience in robotic-assisted thoracic surgery for early stage lung cancer. Thorac Cardiovasc Surg Rep 2018; 67(7): 564–572. doi: 10.1055/s-0038-1639575.
19. Park BJ. Robotic lobectomy for non-small cell lung cancer. Thorac Surg Clin 2014; 24(2): 157–162. doi: 10.1016/j.thorsurg.2014.02.011.
20. Toosi K, Velez-Cubian FO, Glover J et al. Upstaging and survival after robotic-assisted thoracoscopic lobectomy for non-small cell lung cancer. Surgery 2016; 160(5): 1211–1218. doi: 10.1016/j.surg.2016.08.003.
21. Shahin GM, Topal B, Sjaak P et al. Quality assessment of robot assisted thoracic surgical resection of non-small cell lung cancer: nodal upstaging and mediastinal recurrence. J Thorac Dis 2021; 13(2): 592–599. doi: 10.21037/jtd-20-2267.
22. Shindo Y, Miyajima M, Nakamura Y et al. Number of lymph nodes dissected and upstaging rate of the N factor in robot-assisted thoracic surgery versus video-assisted thoracic surgery for patients with cN0 primary lung cancer. Surg Today 2022; 53(4): 428–434. doi: 10.1007/s00595-022-02578-5.
23. Gallina FT, Melis E, Forcella D et al. Nodal upstaging evaluation after robotic-assisted lobectomy for early-stage non-small cell lung cancer compared to video-assisted thoracic surgery and thoracotomy: a retrospective single center analysis. Front Surg 2021; 8 : 666158. doi: 10.3389/fsurg.2021.666158.
24. Toker A, Özyurtkan MO, Demirhan Ö et al. Lymph node dissection in surgery for lung cancer: comparison of open vs. video-assisted vs. robotic-assisted approaches. Ann Thorac Cardiovasc Surg 2016; 22(5): 284–290. doi: 10.5761/atcs.oa.16-00087.
25. Novellis P, Maisonneuve P, Dieci E et al. Quality of life, postoperative pain, and lymph node dissection in a robotic approach compared to VATS and OPEN for early stage lung cancer. J Clin Med 2021; 10(8): 1687. doi: 10.3390/jcm10081687.
26. Bao F, Zhang C, Yang Y et al. Comparison of robotic and video-assisted thoracic surgery for lung cancer: a propensity-matched analysis. J Thorac Dis 2016; 8(7): 1798–1803. doi: 10.21037/jtd.2016.05.99.
27. Goossen K, Hess S, Lunny C et al. Database combinations to retrieve systematic reviews in overviews of reviews: a methodological study. BMC Med Res Methodol 2020; 20(1): 138. doi: 10.1186/s12874-020-00983-3.
28. Gusenbauer M, Haddaway NR. Which academic search systems are suitable for systematic reviews or meta-analyses? Evaluating retrieval qualities of Google scholar, PubMed, and 26 other resources. Res Synth Methods 2020; 11(2): 181–217. doi: 10.1002/jrsm.1378.
29. Asemota N, Alessandro M, Savvas L et al. Comparison of quality of life after robotic, video-assisted, and open surgery for lung cancer. J Clin Med 2023; 12(19): 6230. doi: 10.3390/jcm12196230.
30. Veronesi G, Novellis P, Voulaz E et al. Robot-assisted surgery for lung cancer: state of the art and perspectives. Lung Cancer 2016; 101 : 28–34. doi: 10.1016/j.lungcan.2016.09.004.
31. Liu S, Li S, Tang Y et al. Minimally invasive surgery vs. open thoracotomy for non-small-cell lung cancer with N2 disease: a systematic review and meta-analysis. Front Med 2023; 10 : 1152421. doi: 10.3389/fmed.2023.1152421.
32. Hu J, Chen Y, Dai J et al. Perioperative outcomes of robot-assisted vs video-assisted and traditional open thoracic surgery for lung cancer: a systematic review and network meta-analysis. Int J Med Robot Comp 2020; 16(5): 1–14. doi: 10.1002/rcs.2123.
MUDr. Dávid Adamica
Chirurgická klinika
LF OU a FN Ostrava
17. listopadu 1790/5
708 00 Ostrava
david.adamica@fno.cz
Don‘t have an account? Create new account
Enter the email address that you registered with. We will send you instructions on how to set a new password.
