Uniportal versus multiportal nonintubated thoracoscopic anatomical resection for lung cancer: A propensity-matched analysis

• DOI: 10.1016/j.jfma.2023.04.012
• Publication Date: 2023-05-09T21:29:35Z
• Authors: Jen-Hao Chuang; Pei-Hsing Chen; Tzu-Pin Lu; Wan-Ting Hung; Hsien-Chi Liao; Tung-Ming Tsai; Mong-Wei Lin; Ke-Cheng Chen; Hsao-Hsun Hsu; Jin-Shing Chen
• Keywords: Medicine (General); Lung Neoplasms; Nonintubated surgery; Thoracic Surgery, Video-Assisted; Lung cancer surgery; Anatomical resection; Uniportal thoracoscopic surgery; 3. Good health; R5-920; Carcinoma, Non-Small-Cell Lung; Humans; Pneumonectomy; Lung; Thoracoscopy/VATS; Retrospective Studies

No studies have compared between uniportal and multiportal nonintubated thoracoscopic anatomical resection for non-small cell lung cancer (NSCLC). We aimed to compare short- and long-term postoperative outcomes concerning these two methods.Our retrospective dataset comprised patients with NSCLC who underwent uniportal or multiportal nonintubated thoracoscopic anatomical resection between January 2011 and December 2019. The primary outcome was recurrence-free survival. Propensity scores were matched according to age, sex, body mass index, pulmonary function, tumor size, cancer stage, and surgical method.In total, 1130 such patients underwent nonintubated video-assisted thoracoscopic surgery (VATS), and 490 consecutive patients with stage I-III NSCLC underwent nonintubated anatomical resection, including lobectomy and segmentectomy (uniportal, n = 158 [32.3%]; multiportal, n = 331 [67.7%]). The uniportal group had fewer dissected lymph nodes and lymph node stations. In paired group analysis, the uniportal group had shorter operation durations (99.8 vs. 138.2 min; P < 0.001), lower intensive care unit (ICU) admission rates and ICU admission intervals (7.0% vs. 27.8%; P < 0.001), and shorter postoperative hospital stays (4.1 days vs. 5.2 days; P < 0.001). The most common postoperative complication was prolonged air leaks. No surgical mortality was observed. The multiportal group had higher complication rates for grades ≥ II NSCLC; however, this difference was not significant (4.4% vs. 1.3%, respectively; P = 0.09).Nonintubated uniportal VATS for anatomical resection had better results for some perioperative outcomes than multiportal VATS. Oncological outcomes such as recurrence-free and overall survival remained uncompromised, despite fewer dissected lymph nodes.