本研究旨在分析有经验的胸科医生在多个机构中执行的机器人辅助叶切除术（RL）、视频辅助胸腔镜叶切除术（VATS）和开放性叶切除术（OL）的总生存率。近年来，外科医生越来越多地采用RL来切除早期肺癌。这些方法的比较生存数据主要来自单一机构的病例系列或行政数据集。回顾性数据来自2013年至2019年的21个机构。纳入了对临床I期至IIIA期肺癌进行的连续手术案例，不包括诱导治疗患者。采用倾向得分方法的倒数概率治疗加权（IPTW）来平衡基线特征。使用Kaplan-Meier方法估计总生存率（OS）。多元Cox比例风险模型用于评估与OS和相关风险因素之间的关联。共纳入了2,789例RL、2,661例VATS和1,196例OL案例。未经调整的5年总生存率最高为OL（84%），其次是RL（81%）和VATS（74%）； P = 0.008。经过IPTW调整后也观察到类似的趋势（RL 81%；VATS 73%，OL 85%，P = 0.001）。多变量Cox回归分析表明，与VATS相比，OL和RL与明显更高的总生存率相关（OL vs VATS：HR 0.64，P <0.001；RL vs VATS：HR 0.79；P = 0.007）。我们从这个大型多中心研究中发现，接受RL和OL手术的患者具有统计学上相似的OS，而VATS组则与较短的OS相关。需要进行更长期的随访研究来评估这些观察结果。版权所有©2023 Wolters Kluwer Health，Inc.。保留所有权利。

The aim of this study was to analyze overall survival of robotic-assisted lobectomy (RL), video-assisted thoracoscopic lobectomy (VATS) and open lobectomy (OL) performed by experienced thoracic surgeons across multiple institutions.Surgeons have increasingly adopted RL for resection of early-stage lung cancer. Comparative survival data following these approaches is largely from single-institution case series or administrative datasets.Retrospective data was collected from 21 institutions from 2013-2019. Consecutive cases performed for clinical stage IA-IIIA lung cancer were included. Induction therapy patients were excluded. The propensity-score method of inverse-probability of treatment weighting (IPTW) was used to balance baseline characteristics. Overall survival (OS) was estimated using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to evaluate association among OS and relevant risk factors.A total of 2,789 RL, 2,661 VATS, and 1,196 OL cases were included. The unadjusted 5-year overall survival rate was highest for OL (84%) followed by RL (81%) and VATS (74%); P=0.008. Similar trends were also observed after IPTW adjustment (RL 81%; VATS 73%, OL 85%, P=0.001). Multivariable Cox regression analyses revealed that OL and RL were associated with significantly higher overall survival compared to VATS (OL vs. VATS: HR 0.64, P<0.001 and RL vs. VATS: HR 0.79; P=0.007).Our finding from this large multicenter study suggests that patients undergoing RL and OL have statistically similar OS, while the VATS group was associated with shorter OS. Further studies with longer follow-up are necessary to help evaluate these observations.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.