Efficacy of Single-Port Video-Assisted Thoracoscopic Surgery Lobectomy Compared with Triple-Port VATS by Propensity Score Matching

Abstract

BackgroundIn recent years, single-port video-assisted thoracoscopic surgery (VATS) for lobectomy in non-small cell lung cancer (NSCLC) patients has become increasingly common. The objective of this study was to compare the feasibility and safety of single-port and triple-port VATS lobectomy.MethodsA total of 73 patients with NSCLC who underwent VATS lobectomy from December 2011 to August 2016 were retrospectively reviewed, including 47 in the triple-port group and 26 in the single-port group. Statistical analysis was performed after propensity score matching. Patients were matched on a 1-to-1 basis.ResultsOperative time and intraoperative blood loss in the triple-port group and the single-port group were similar (189.4±50.8 minutes vs. 205.4±50.6 minutes, p=0.259; 286.5±531.0 mL vs. 314.6±513.1 mL, p=0.813). There were no cases of morbidity or mortality. No significant differences in complications or the total number of dissected lymph nodes were found between the 2 groups. In the single-port group, more mediastinal lymph nodes were dissected than in the triple-port group (1.7±0.6 vs. 1.2±0.5, p=0.011). Both groups had 1 patient with bronchopleural fistula. Chest tube duration and postoperative hospital stay were shorter in the single-port group than in the triple-port group (8.7±5.1 days vs. 6.2±6.6 days, p=0.130; 11.7±6.1 days vs. 9.5±6.4 days, p=0.226). However, the differences were not statistically significant. In the single-port group, the rate of conversion to multi-port VATS lobectomy was 11.5% (3 of 26). The rates of conversion to open thoracotomy in the triple-port and single-port groups were 7.7% and 3.8%, respectively (p=1.000).ConclusionIn comparison with the triple-port group, single-port VATS lobectomy showed similar results in safety and efficacy, indicating that single-port VATS lobectomy is a feasible and safe option for lung cancer patients.

Optimal Approach to Lobectomy for Non-Small Cell Lung Cancer: Systemic Review and Meta-Analysis

“…18,21,36,50,61,81,85,95,147 Thirteen studies compared mVATS to uVATS. 35,53,57,59,70,72,91,93,126,138,141,142,177 One study compared rVATS to open lobectomy. 154 One study compared uVATS to open lobectomy.…”

Comparison of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy

“…Since Rocco et al [1] reported the first single-port VATS wedge resection in 2004, the frequency of uniportal VATS procedures has been increasing. Because it requires only a single incision, uniportal VATS minimizes injury to the chest wall and intercostal nerves, which in turn has the obvious advantage of minimizing postoperative pain [9], and propensity score matching analyses comparing the outcomes of uniportal and multiportal VATS lobectomy in patients with lung cancer have confirmed that the uniportal and multiportal approaches are similar in terms of safety and efficacy [5,6].…”

Uniportal video-assisted thoracoscopy surgery in lung cancer: largest experience

“…A number of publications have focused on this technique, but they are mainly case reports and small series. 6–14 Ismail and colleagues, 8 Duan and colleagues, 10 and Erşen and colleagues 11 discussed their experience of UVATS for lobar and sublobar resections for lung cancer and found it to be noninferior to conventional multiport VATS in terms of surgical outcomes, and better in terms of postoperative recovery and hospital stay. However, a multicentric randomized trial concluded that sublobar resection is not a standard of care for the management of lung cancer, and it was associated with increased locoregional recurrence rates without any significant improvement in perioperative morbidity and mortality, recommending that sublobar resection be performed only in patients with significantly reduced pulmonary reserve.…”