Supplemental Table 1: Participating Institutions
Albany Medical Center- Albany, New York
Allegheny Health Network- Pittsburgh, Pennsylvania Aurora Research Institute- Milwaukee, Wisconsin Baptist Health South Florida- Miami, Florida Baylor Scott and White Health- Dallas, Texas
Beth Israel Deaconess Medical Center- Boston, Massachusetts Duke University Medical Center- Durham, North Carolina Mayo Clinic- Rochester, Minnesota
Main Line Health/Lankenau Institute for Medical Research- Wynnewood, Pennsylvania MD Anderson Cancer Center- Houston, Texas
Northwell Health- Manhasset, New York
New York University- Langone- New York, New York New York University- Winthrop- New York, New York Orlando Health- Orlando, Florida
Penn State Cancer Institute- Hershey, Pennsylvania Swedish Cancer Institute- Seattle, Washington Temple University- Philadelphia, Pennsylvania University of Michigan- Ann Arbor, Michigan
University of Alabama at Birmingham- Birmingham, Alabama
University of Pittsburgh Medical Center- Pittsburgh, Pennsylvania
Washington University- St. Louis, Missouri
Supplemental Table 2. Pairwise comparisons of the baseline characteristics for robotic lobectomy (RL), open, and video-assisted thoracoscopic (VATS) lobectomy: prior to propensity score matching.
P-value
Characteristic RL
(n=2391)
VATS (n=2174)
Open (n=1156)
RL vs Open
VATS vs Open
RL vs VATS Demographics
Age, years (±SD) 67.8±9.7 67.5±9.3 65.8±10.4 <0.0001 <0.0001 0.17
Sex, n (%) <0.0001 0.04 0.01
Female [reference level] 1355 (56.7) 1151 (52.9) 569 (49.2)
Male 1036 (43.3) 1023 (47.1) 587 (50.8)
BMI, Mean±SD 28.0 ± 6.1 27.7 ± 5.8 28.2 ± 7.5 0.3827 0.0617 0.1917
Patient characteristics
Smoking status, n (%) <0.0001 0.0012 0.02
Current smoker 482 (20.2) 376 (17.3) 144 (12.5) Never smoked 473 (19.8) 414 (19.1) 228 (19.8) Past smoker [reference level] 1429 (59.9) 1383 (63.6) 782 (67.8)
Zubrod score, n (%) <0.0001 <0.0001 <0.0001
0 1116 (46.7) 1306 (60.1) 782 (67.6)
1 1074 (44.9) 792 (36.4) 330 (28.5)
2 163 (6.8) 68 (3.1) 38 (3.3)
3 35 (1.5) 8 (0.4) 5 (0.4)
4 3 (0.1) 1 (0.1)
ASA grade n (%) <0.0001 0.0005 0.0001
I 38 (1.6) 35 (1.6) 57 (4.9)
II 477 (20.0) 465 (21.4) 275 (23.8)
III 1685 (70.8) 1613 (74.4) 785 (68.0)
IV 189 (7.6) 56 (2.6) 37 (3.2)
Pulmonary Function Test
FEV1 predicted, % (±SD) 85.0±19.7 85.9±19.7 (2073) 85.9±20.2 0.008 0.16 0.15
Clinical staging
Tumor size, cm (±SD) 2.7±1.6 2.7±1.6 3.8±3.6 <0.0001 <0.0001 0.95
T stage, n (%) <0.0001 <0.0001 0.0031
T1a 1004 (42.0) 825 (37.95) 265 (22.9)
T1b 614 (25.7) 584 (26.9) 266 (23.0)
P-value
Characteristic RL
(n=2391)
VATS (n=2174)
Open (n=1156)
RL vs Open
VATS vs Open
RL vs VATS
T2a 468 (19.6) 440 (20.2) 306 (26.5)
T2b 105 (4.4) 117 (5.4) 121 (10.5)
T3 144 (6.0) 120 (5.5) 165 (14.3)
T4 56 (2.3) 88 (4.05) 33 (2.85)
N stage, n (%) <0.0001 <0.0001 0.06
N0 2195 (91.8) 2028 (93.3) 937 (81.1)
N1 147 (6.15) 102 (4.7) 121 (10.5)
N2 49 (2.05) 44 (2.02) 98 (8.48)
TNM stage, n (%) <0.0001 <0.0001 0.17
IA 1523 (63.7) 1344 (61.2) 259 (39.7)
IB 411 (17.2) 401 (18.45) 246 (21.3)
IIA 207 (8.7) 169 (7.8) 162 (14.0)
IIB 126 (5.3) 120 (5.5) 135 (11.7)
IIIA 124 (5.2) 140 (6.4) 154 (13.2)
RL = robotic-assisted lobectomy; VATS = video-assisted thoracoscopic surgery; SD = standard deviation of the mean; ASA = American Society of Anesthesiologists; PFTs = pulmonary function tests; FEV = forced expiratory volume; TNM = tumor-nodal-metastasis
Supplemental Table 3: Pairwise comparisons of the baseline characteristics for robotic lobectomy (RL), open, and video-assisted thoracoscopic (VATS) lobectomy following propensity score matching.
Characteristic RL versus OL VATS versus OL RL versus VATS RL
(n=885)
OL (n=885)
p-value VATS (n=952)
OL (n=952)
p-value RL
(n=1711)
VATS (n=1711)
p- value Demographics
Age, years (±SD) 66.7±10.1 66.6±10.
1
0.95 66.7±9.9 66.3±10.2 0.29 67.8±9.7 67.9±9.0 0.96
Sex, n (%) 0.23 0.19 0.53
Female (reference level)
479 (54.1) 456 (51.5)
453 (47.6) 470 (49.4) 969 (56.6) 952 (55.6)
Male 406 (45.9) 429
(48.5)
499 (52.4) 482 (50.6) 742 (43.4) 759 (44.4) BMI, Mean±SD
28.1 ± 6.2 28.2 ±
6.2 0.68 27.7 ± 5.7 28.1 ± 6.2 0.50 28.0 ± 6.2 27.7 ± 5.9 0.21 Patient characteristics
Smoking statusa, n (%) 0.73 0.22 0.04
Current smoker 137 (15.5) 128 (14.5)
162 (17.0) 139 (14.6) 364 (21.3) 321 (18.8) Never smoked 186 (21.0) 174
(19.7)
177 (18.6) 182 (19.1) 329 (19.2) 326 (19.1) Past smoker
(reference level)
562 (63.5) 583 (65.9)
613 (64.4) 631 (66.3) 1018 (59.5) 1064 (62.2)
Zubrod score, n (%) 0.02 0.13 0.09
0 524 (59.2) 571
(64.5)
593 (62.3) 642 (67.4) 855 (50.0) 893 (52.2)
1 326 (36.8) 274
(31.0)
331 (34.8) 270 (28.4) 775 (45.3) 750 (43.8)
2 29 (3.3) 36 (4.1) 23 (2.4) 36 (3.8) 75 (4.4) 62 (3.6)
3 5 (0.6) 4 (0.5) 5 (0.5) 4 (0.4) 6 (0.4) 6 (0.4)
4 1 (0.1)
ASA grade, n (%) 0.63 0.10 0.70
I 21 (2.4) 32 (3.6) 16 (1.7) 39 (4.1) 30 (1.8) 20 (1.2)
II 227 (25.6) 197
(22.3)
226 (23.7) 212 (22.3) 370 (21.6) 343 (20.0)
III 595 (67.2) 625
(70.6)
690 (72.5) 668 (70.2) 1202 (70.3) 1296 (75.7)
IV 42 (4.7) 31 (3.5) 20 (2.1) 33 (3.5) 109 (6.4) 52 (3.0)
Pulmonary Function Test
FEV-1 predicteda, % (±SD)
86.6±20.0 86.4
±19.1
0.74 86.5±20.4 86.4±19.3 0.76 85.7±19.6 85.7±20.4 0.80 Tumor Location
Left Upper Lobe 219 245 205 260 395 377
Characteristic RL versus OL VATS versus OL RL versus VATS RL
(n=885) OL
(n=885) p-value VATS
(n=952) OL
(n=952) p-value RL
(n=1711) VATS
(n=1711) p- value
(24.75%) (27.75%) (21.53%) (27.37%) (23.09%) (22.03%)
Left Lower Lobe 124 (14.01%)
158 (17.89%)
177 (18.59%)
169 (17.79%)
259 (15.14%)
282 (16.48%) Right Upper Lobe 291
(32.88%) 279
(31.60%) 319
(33.51%) 308
(32.42%) 557
(32.55%) 604 (35.30%) Right Middle Lobe 75
(8.47%)
64
(7.31%) 79 (8.3%) 67
(7.03%)
153
(8.94%) 147 (8.6%) Right Lower Lobe 176
(19.89%)
137 (15.52%)
172 (18.07%)
146 (15.37%)
347 (20.28%)
301 (17.59%) Clinical staging
Tumor size, cm (±SD) 3.1±1.8 3.4±2.0 0.0002 3.2±1.9 3.5±2.0 0.0002 2.6±1.5 2.7±1.6 0.05
T stage, n (%) 0.28 0.44 0.14
T1a 290 (32.8) 235
(26.6)
284 (29.8) 238 (25.0) 747 (43.7) 690 (40.3)
T1b 165 (18.6) 228
(25.8)
181 (19.0) 235 (24.7) 425 (24.8) 457 (26.7)
T2a 260 (29.4) 227
(25.7)
288 (30.3) 251 (26.4) 326 (19.1) 345 (20.2)
T2b 57 (6.4) 81 (9.2) 77 (8.1) 95 (10.0) 73 (4.3) 88 (5.1)
T3 83 (9.4) 96 (10.9) 79 (8.3) 108 (11.3) 94 (5.5) 78 (4.6)
T4 30 (3.4) 18 (2.0) 43 (4.5) 25 (2.6) 46 (2.7) 53 (3.1)
N stage, n (%) 0.70 0.45 0.85
N0 763 (86.2) 771
(87.1)
836 (87.8) 823 (86.5) 1584 (92.6) 1589 (92.9)
N1 85 (9.6) 79 (8.9) 77 (8.1) 85 (8.9) 94 (5.5) 88 (5.1)
N2 37 (4.2) 35 (4.0) 39 (4.1) 44 (4.6) 33 (1.9) 34 (2.0)
TNM stage, n (%) 0.94 0.32 0.62
IA 406 (45.9) 409
(46.2)
425 (44.6) 409 (43.0) 1111 (64.9) 1088 (63.6)
IB 219 (24.8) 199
(22.5)
250 (26.3) 223 (23.4) 286 (16.7) 314 (18.4)
IIA 110 (12.4) 122
(13.8)
107 (11.2) 139 (14.6) 140 (8.2) 132 (7.7)
IIB 67 (7.6) 87 (9.8) 81 (8.5) 97 (10.2) 84 (4.9) 85 (5.0)
IIIA 83 (9.4) 68 (7.7) 89 (9.4) 84 (8.8) 90 (5.3) 92 (5.4)
RL = robotic-assisted lobectomy; OL = open lobectomy; VATS = video-assisted thoracoscopic surgery;
SD = standard deviation of the mean; BMI = body mass index; ASA = American Society of Anesthesiologists; FEV = forced expiratory volume; TNM = tumor-nodal-metastasis
a < 7% data missing
Supplemental Table 4. Propensity-matched pairwise comparisons of the intraoperative details for RL, VATS, and OL cases.
Variable RL versus OL VATS versus OL RL versus VATS
RL (n=885)
OL (n=885)
p-value VATS (n=952)
OL (n=952)
p-value RL
(n=1711)
VATS (n=1711)
p-value Operating
room time, min (±SD) a With
Concomitant Procedures
257.1
±88.2 (N=384)
300.9 ±99.2 (N=394)
<.0001 297.7
±84.5 (N=556)
302.8 ±101.3 (N=422)
0.9796 256.3
±88.5 (N=756)
296.4
±86.6 (N=962)
<.0001
Without Concomitant Procedures
229.4±91.0 (N=500)
237.7±65.2 (N=408)
0.0004 257.4±84.
9 (N=389)
237.3±64.5 (N=447)
0.01 228.7±87.1 (N=953)
250.5±83.
6 (N=739)
<0.0001
Procedure time, min (±SD) a With
Concomitant Procedures
189.5
±75.9 (N=384)
224.6 ±97.0 (N=394)
<.0001 223.8
±82.1 (N=556)
226.0 ±99.7 (N=433
0.75 189.4
±77.5 (N=756)
222.5
±84.1 (N=962)
<.0001
Without Concomitant Procedures
166.4±80.1 (N=500)
163.9±58.3
(N=480) 0.16
188.1±74.
4(N=396)
163.7±57.4
(N=384) <0.0001
164.5±75.3 (N=954)
181.3±73.
6(N=749) <0.0001 Major
concomitant procedures, n (%)
384
(43.4%) 403 (45.5%) 0.34 556
(58.4%) 434 (45.6%) <0.0001 756 (44.2%)
962
(56.2%) <0.0001 Conversion,
n (%) c 68 (4.0) 173 (10.1) <0.0001
Estimated blood loss, mL (±SD) d
86.6±150.9 215.9±278.0 <0.0001 170.0±23 0.6
217.0±264.9 <0.0001 87.1±157.6 170.0±30 5.4
<0.0001 Intraoperative
blood transfusion, n (%)
3 (0.3) 27 (3.1) <0.0001 15 (1.6) 30 (3.2) 0.06 15 (0.9) 26 (1.5) 0.08
RL = robotic-assisted lobectomy; OL = open lobectomy; VATS = video-assisted thoracoscopic surgery;
SD = standard deviation of the mean
a Time measured from entry into operating room to exit (wheels in to wheels out)
b Time measured from first incision to close (skin to skin)
c 59 RAS cases (86.8%) were converted to open; 9 RAS cases (13.2%) were converted to VATS; 173 VATS cases (100.0%) were converted to open.
d<1% of data missing for that specific outcome