Robotic approach has improved outcomes for minimally invasive resection of mediastinal tumors.

Abstract Background The optimal minimally invasive surgical (MIS) approach to mediastinal tumors is unknown. There are limited reports comparing the outcomes of resection with robotic-assisted and video-assisted thoracoscopy (RATS vs VATS). We hypothesized that patients who underwent RATS would have improved outcomes. Methods The National Cancer Database was queried for all patients who underwent MIS for any mediastinal tumor from 2010-2016. Patients were determined to have an adverse composite outcome if they had any of the adverse perioperative outcomes; conversion to open procedure, 90-day mortality, 30-day readmission, and positive pathologic margins. Secondary outcomes of interest were length-of-stay (LOS) and overall survival. Multivariable logistic regression was used to assess likelihood of having a composite adverse outcome based on surgical approach. Results 856 patients were included: 402 (47%) underwent VATS and 454 (53%) underwent RATS. RATS resections were associated with fewer conversions (4.9% vs 14.7%, p 4 cm (OR 0.45, p=0.001). Overall survival was similar between the two groups. Conclusions Among patients who underwent MIS for a mediastinal tumor, RATS had fewer adverse outcomes than VATS, even for tumors ≥ 4 cm. These data suggests that RATS may be the preferred technique for patients who are candidates for minimally invasive resection of mediastinal tumors.