{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:04:33Z","timestamp":1792793073528,"version":"4.5.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T00:00:00Z","timestamp":1631145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004710","name":"Fondazione Umberto Veronesi","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004710","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010477","name":"Intuitive Surgical","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010477","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>We report the results of the first prospective international randomized control trial to compare the perioperative outcome and surgical radicality of the robotic approach with those of traditional video-assisted surgery in the treatment of early-stage lung cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with clinical stage T1\u2013T2, N0\u2013N1 non-small cell lung cancer (NSCLC) were randomly assigned to robotic-assisted thoracoscopic surgery (RATS) or video-assisted thoracic surgery (VATS) resection arms. The primary objective was the incidence of adverse events including complications and conversion to thoracotomy. The secondary objectives included extent of lymph node (LN) dissection and other indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This trial was closed at 83 cases as the probability of concluding in favor of the robot arm for the primary outcome was null according to the observed trend. In this study, we report the results of the analysis conducted on the patients enrolled until trial suspension. Thirty-nine cases were randomized in the VATS arm and 38 in the robotic arm. Six patients were excluded from analysis. Despite finding no difference between the two arms in perioperative complications, conversions, duration of surgery, or duration of postoperative stay, a significantly greater degree of LN assessment by the robotic technique was observed in regards to the median number of sampled LN stations [6, interquartile range (IQR) 4\u20136\n                      <jats:italic>vs<\/jats:italic>\n                      . 4, IQR 3\u20135;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0002], hilar LNs (7, IQR 5\u201310\n                      <jats:italic>vs<\/jats:italic>\n                      . 4, IQR 2\u20137;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0003), and mediastinal LNs (7, IQR 5\u201310\n                      <jats:italic>vs<\/jats:italic>\n                      . 5, IQR 3\u20137;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results of this trial demonstrated that RATS was not superior to VATS considering the perioperative outcome for early-stage NSCLC, but the robotic approach allowed an improvement of LN dissection. Further studies are suggested to validate the results of this trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>clinicaltrials.gov, identifier NCT02804893.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2021.726408","type":"journal-article","created":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T04:42:59Z","timestamp":1631162579000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":97,"title":["Perioperative Outcome of Robotic Approach Versus Manual Videothoracoscopic Major Resection in Patients Affected by Early Lung Cancer: Results of a Randomized Multicentric Study (ROMAN Study)"],"prefix":"10.3389","volume":"11","author":[{"given":"Giulia","family":"Veronesi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbas El-Sayed","family":"Abbas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piergiorgio","family":"Muriana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalba","family":"Lembo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Bottoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Perroni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Testori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Dieci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles T.","family":"Bakhos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamus","family":"Car","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Luzzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Alloisio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Novellis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.jtcvs.2009.10.025","article-title":"Four-Arm Robotic Lobectomy for the Treatment of Early-Stage Lung Cancer","volume":"140","author":"Veronesi","year":"2010","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2011.07.022","article-title":"Initial Consecutive Experience of Completely Portal Robotic Pulmonary Resection With 4 Arms","volume":"142","author":"Cerfolio","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2005.07.031","article-title":"Robotic Assistance for Video-Assisted Thoracic Surgical Lobectomy: Technique and Initial Results","volume":"131","author":"Park","year":"2006","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1097\/IMI.0b013e3182490093","article-title":"Experience With Robotic Lobectomy for Lung Cancer","volume":"6","author":"Veronesi","year":"2011","journal-title":"Innov Technol Tech Cardiothorac Vasc Surg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2020.02.53","article-title":"Robotic Segmentectomy: Indication and Technique","volume":"12","author":"Perroni","year":"2020","journal-title":"J\u00a0Thorac Dis"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.03.048","article-title":"Robotic-Assisted Versus Thoracoscopic Lobectomy Outcomes From High-Volume Thoracic Surgeons","volume":"106","author":"Reddy","year":"2018","journal-title":"Ann Thorac Surg"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2016.03.032","article-title":"Comparison of Video-Assisted Thoracoscopic Surgery and Robotic Approaches for Clinical Stage I and Stage II Non-Small Cell Lung Cancer Using The Society of Thoracic Surgeons Database","volume":"102","author":"Louie","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2011.10.055","article-title":"Robotic Lobectomy for Non-Small Cell Lung Cancer (NSCLC): Long-Term Oncologic Results","volume":"143","author":"Park","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2017.09.016","article-title":"The Long-Term Survival of Robotic Lobectomy for Non\u2013Small Cell Lung Cancer: A Multi-Institutional Study","volume":"155","author":"Cerfolio","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2017.06.020","article-title":"Robotic-Assisted, Video-Assisted Thoracoscopic and Open Lobectomy: Propensity-Matched Analysis of Recent Premier Data","volume":"104","author":"Oh","year":"2017","journal-title":"Ann Thorac Surg"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2018.01.123","article-title":"Robotic Surgery, Video-Assisted Thoracic Surgery, and Open Surgery for Early Stage Lung Cancer: Comparison of Costs and Outcomes at a Single Institute","volume":"10","author":"Novellis","year":"2018","journal-title":"J Thorac Dis"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2016.01.004","article-title":"The Use of Robotic-Assisted Thoracic Surgery for Lung Resection: A Comprehensive Systematic Review","volume":"28","author":"Agzarian","year":"2016","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1016\/j.jtcvs.2019.06.113","article-title":"Propensity-Score Adjusted Comparison of Pathologic Nodal Upstaging by Robotic, Video-Assisted Thoracoscopic, and Open Lobectomy for non\u2013Small Cell Lung Cancer","volume":"158","author":"Kneuertz","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.12.6649","article-title":"Video-Assisted Thoracic Surgery Lobectomy: Report of CALGB 39802 - A Prospective, Multi-Institution Feasibility Study","volume":"25","author":"Swanson","year":"2007","journal-title":"J Clin Oncol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2006.08.008","article-title":"ESTS Guidelines for Intraoperative Lymph Node Staging in Non-Small Cell Lung Cancer","volume":"30","author":"Lardinois","year":"2006","journal-title":"Eur J Cardio Thorac Surg"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2019.10.019","article-title":"The IASLC Lung Cancer Staging Project: Analysis of Resection Margin Status and Proposals for Residual Tumor Descriptors for Non-Small Cell Lung Cancer","volume":"15","author":"Edwards","year":"2020","journal-title":"J\u00a0Thorac Oncol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.lungcan.2005.01.001","article-title":"Complete Resection in Lung Cancer Surgery: Proposed Definition","volume":"49","author":"Rami-Porta","year":"2005","journal-title":"Lung Cancer"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2016.04.012","article-title":"Robotic Assisted Thoracic Surgery Lobectomy Versus Video Assisted Thoracic Surgery Lobectomy: Is a Randomized Trial Really Necessary","volume":"28","author":"Korst","year":"2016","journal-title":"Semin Thorac Cardiovas Surg"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-010-0661-7","article-title":"Video-Assisted Thoracoscopic Surgery Lobectomy for Lung Cancer: The Learning Curve","volume":"34","author":"Zhao","year":"2010","journal-title":"World J Surg"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.thorsurg.2008.06.001","article-title":"Robotically Assisted Lobectomy: Learning Curve and Complications","volume":"18","author":"Melfi","year":"2008","journal-title":"Thorac Surg Clin"},{"key":"B21","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/s12957-017-1168-6","article-title":"Feasibility and Safety of Robot-Assisted Thoracic Surgery for Lung Lobectomy in Patients With non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis","volume":"15","author":"Wei","year":"2017","journal-title":"World J Surg Oncol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2013.09.046","article-title":"Comparing Robot-Assisted Thoracic Surgical Lobectomy With Conventional Video-Assisted Thoracic Surgical Lobectomy and Wedge Resection: Results From a Multihospital Database (Premier)","volume":"147","author":"Swanson","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2019.10.48","article-title":"Current Status and Evolution of Robotic-Assisted Thoracic Surgery in Germany\u2014Results From a Nationwide Survey","volume":"11","author":"M\u00f6ller","year":"2019","journal-title":"J Thorac Dis"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2016.05.99","article-title":"Comparison of Robotic and Video-Assisted Thoracic Surgery for Lung Cancer: A Propensity-Matched Analysis","volume":"8","author":"Bao","year":"2016","journal-title":"J Thorac Dis"},{"key":"B25","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.jtho.2015.09.009","article-title":"The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer","volume":"11","author":"Goldstraw","year":"2016","journal-title":"J Thorac Oncol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-019-01939-x","article-title":"Predictors of Nodal Upstaging in Patients With Ct1-3N0 Non-Small Cell Lung Cancer (NSCLC): Results From the Italian VATS Group Registry","volume":"50","author":"Marulli","year":"2019","journal-title":"Surg Today"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezz320","article-title":"The Association of Nodal Upstaging With Surgical Approach and Its Impact on Long-Term Survival After Resection of Non-Small-Cell Lung Cancer","volume":"57","author":"Hennon","year":"2020","journal-title":"Eur J Cardio Thorac Surg"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2019.12.112","article-title":"Early Outcomes of Robotic Versus Thoracoscopic Segmentectomy for Early-Stage Lung Cancer: A Multi-Institutional Propensity Score-Matched Analysis","volume":"60","author":"Zhang","year":"2020","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.5761\/atcs.oa.16-00087","article-title":"Lymph Node Dissection in Surgery for Lung Cancer: Comparison of Open vs. Video-Assisted vs. Robotic-Assisted Approaches","volume":"22","author":"Toker","year":"2016","journal-title":"Ann Thorac Cardiovasc Surg"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.2174\/1386207322666190411113040","article-title":"Efficacy and Safety of Robot-Assisted Thoracic Surgery (RATS) Compare With Video-Assisted Thoracoscopic Surgery (VATS) for Lung Lobectomy in Patients With Non-Small Cell Lung Cancer","volume":"22","author":"Hu","year":"2019","journal-title":"Comb Chem High Throughput Screen"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001708","article-title":"Long-Term Survival Based on the Surgical Approach to Lobectomy for Clinical Stage I Nonsmall Cell Lung Cancer: Comparison of Robotic, Video-Assisted Thoracic Surgery, and Thoracotomy Lobectomy","volume":"265","author":"Yang","year":"2017","journal-title":"Ann Surg"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1177\/1556984519845672","article-title":"Successful Transition to Robotic-Assisted Lobectomy With Previous Proficiency in Thoracoscopic Lobectomy","volume":"14","author":"Merritt","year":"2019","journal-title":"Innov. Technol Tech. Cardiothorac. Vasc Surg"},{"key":"B33","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1186\/s12885-021-08241-5","article-title":"Robot-Assisted Thoracic Surgery Versus Video-Assisted Thoracic Surgery for Lung Lobectomy or Segmentectomy in Patients With Non-Small Cell Lung Cancer: A Meta-Analysis","volume":"21","author":"Ma","year":"2021","journal-title":"BMC Cancer"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezy166","article-title":"Robotic Resection of Stage III Lung Cancer: An International Retrospective Study","volume":"54","author":"Veronesi","year":"2018","journal-title":"Eur J Cardio Thorac Surg"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2007.05.007","article-title":"Anatomic Segmentectomy in the Treatment of Stage I Non-Small Cell Lung Cancer","volume":"84","author":"Schuchert","year":"2007","journal-title":"Ann Thorac Surg"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.cllc.2019.03.006","article-title":"Node-Positive Segmentectomy for Non\u2013Small-Cell Lung Cancer: Risk Factors and Outcomes","volume":"20","author":"Lutfi","year":"2019","journal-title":"Clin Lung Cancer"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2021.726408\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T04:43:01Z","timestamp":1631162581000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2021.726408\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,9]]},"references-count":36,"alternative-id":["10.3389\/fonc.2021.726408"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2021.726408","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,9]]},"article-number":"726408"}}