Uniportal video-assisted thoracic surgery reduced the occurrence of post-thoracotomy pain syndrome after lobectomy for lung cancer

Abstract

Background: Post-thoracotomy pain syndrome (PTPS) is difficult for thoracic surgeons to manage. PTPS should never arise after minimally invasive surgery (MIS). Uniportal video-assisted thoracoscopic surgery (U-VATS), a form of MIS for thoracic disease, has become more common around the world and might reduce the risk of PTPS after thoracic surgery. We compared the frequencies of PTPS after U-VATS-based and multi-port VATS (M-VATS)-based lobectomy for lung cancer.

Methods: We compared the data for 142 and 70 cases in which U-VATS- and M-VATS-based lobectomies were performed, respectively. General surgical outcomes, the numeric rating scale (NRS) score, analgesic usage, and neuropathic pain according to the pain DETECT questionnaire (PDQ) were assessed. The presence of >1 of the following items at two postoperative months (POM) was used to diagnose PTPS: (I) an NRS score of >3, (II) analgesic use, and (III) exhibiting >1 of a list of 7 symptoms according to the PDQ.

Results: There were no significant intergroup differences in the operation time, intraoperative blood loss, the number of dissected lymph nodes, or the duration of the drainage period or hospital stay. In the U-VATS and M-VATS groups, the mean NRS score during two postoperative months was 0.5±0.1 and 1.5±0.3, respectively (P<0.01), and analgesics were used for a mean of 7.3±1.5 and 13.3±1.8 days, respectively, during the postoperative 2 months (P<0.01). As for the frequency of PTPS-related symptoms on postoperative month (POM) 2, allodynia (U-VATS: 2.1% vs. M-VATS: 10%, P=0.028), hypoesthesia (2.1% vs. 10%, P=0.028), and numbness (1.4% vs. 8.6%, P=0.029) often arose in both groups. PTPS occurred in 2.8% and 11.4% of the patients in the U-VATS and M-VATS groups, respectively (P=0.025).

Conclusions: Compared with M-VATS, U-VATS exhibited a significantly lower incidence of PTPS.

Keywords: Uniportal video-assisted thoracic surgery (U-VATS); early lung cancer; lobectomy; multiport VATS (M-VATS); post-thoracotomy pain syndrome (PTPS).

Figure 1

Skin incision 1 month after lobectomy in U-VATS and M-VATS. (A) U-VATS: upper/middle lobectomy: 4th intercostal level, anterior axillary line; lower lobectomy: 5th intercostal level, middle axillary line. Mean wound size: 4.2 (3.0–5.0) cm. a, Wrap protector mini. (B) M-VATS: (I) 1.0-cm incision, 8th intercostal space (ICS), mid-axillary line (12-mm trocar); (II) 3–4 cm incision, 5th or 6th ICS, anterior axillary line (Wrap protector); (III) 1.0-cm incision, 7th ICS along the posterior axillary line (12-mm trocar); (IV) When needed, 1.0-cm incision, 3rd ICS, anterior axillary line (5-mm trocar). a, Endopath, 12-mm trocar Ethicon, USA; b, Thoracoport, 5.5 mm-trocar Medotronic, USA. U-VATS, uniportal video-assisted thoracoscopic surgery; M-VATS, multi-port video-assisted thoracoscopic surgery; ICS, intercostal space.

Figure 2

Distribution of lobectomy in U-VATS and M-VATS. (A) M-VATS group and (B) U-VATS group. RU, right upper; RM, right middle; RL, right lower; LU, left upper; LL, left lower; U-VATS, uniportal video-assisted thoracoscopic surgery; M-VATS, multi-port video-assisted thoracoscopic surgery.

Figure 3

NRS evaluation after operation. The NRS was significantly lower in the U-VATS group than in the M-VATS group at 30 and 60 days after operation. *, P<0.05; **, P<0.01. NRS, numeric rating scale; POD, postoperative day; U-VATS, uniportal video-assisted thoracoscopic surgery; M-VATS, multi-port video-assisted thoracoscopic surgery.

Figure 4

The number of days that were used with analgesic agents for 2 months after surgery. The number of days analgesic agents were used was significantly less in U-VATS group than in M-VATS group for 2 months after surgery. *, P<0.05. NSAIDS, pregabalin and tramadol hydrochloride were administered as analgesic agents. U-VATS, uniportal video-assisted thoracoscopic surgery; M-VATS, multi-port video-assisted thoracoscopic surgery; NSAIDS, non-steroid anti-inflammatory drugs.

Figure 5

Frequency of symptoms related to neuropathic pain after surgery on postoperative month 2. The occurrence of allodynia, hypoesthesia and numbness were significantly lower in U-VATS group than in M-VATS group. *, P<0.05. PDQ, pain DETECT questionnaire. U-VATS, uniportal video-assisted thoracoscopic surgery; M-VATS, multi-port video-assisted thoracoscopic surgery.