Objective: This study aims to compare lymphadenectomy between thoracotomy and robotic approaches and to analyze the role of lymph node dissection on survival and recurrence in patients undergoing lobectomy with lymphadenectomy for clinical stage I NSCLC.

Methods: Data from all patients who underwent lobectomy and lymphadenectomy  by robotic or open surgery for stage cI NSCLC between 2016 and 2019 were retrospectively collected and analysed. Preoperative and intraoperative outcomes and details regarding lymphadenectomy and their impact on OS, CSS, and DFS were assessed.

Results: During this period, 197 patients underwent pulmonary lobectomy and lymphadenectomy using robotic (72%) or open (28%) techniques. The results of lymphadenectomy were comparable between the two groups. Perioperative outcomes showed statistically significant longer surgical time, shorter length of stay, shorter chest tube length and fewer complications in the robotic group. The statistical analysis showed that the evaluated lymph node factors did not have a statistically significant on impact OS, CSS, and DFS in the overall cohort , at a median follow-up of 58 months.

Conclusions: The results of this study show how the robotic approach allows for a lymphadenectomy similar to the open technique, with better perioperative outcomes. Furthermore, this study suggests that systematic lymphadenectomy should not be systematically performed when accurate preoperative clinical staging leads to the identification of the early-stage NSCLC.