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. 2019 Dec;11(12):5152-5161.
doi: 10.21037/jtd.2019.12.01.

Uniportal versus multiportal video-assisted thoracic surgery for lung cancer

Mamdoh Al-Ameri  1   2 , Erik Sachs  1   2 , Ulrik Sartipy  1   2 , Veronica Jackson  2
Affiliations

Uniportal versus multiportal video-assisted thoracic surgery for lung cancer

Mamdoh Al-Ameri et al. J Thorac Dis. 2019 Dec.

Abstract

Background: Video-assisted thoracic surgery (VATS) lobectomy is the recommended surgical approach for patients with stage I lung cancer. Whether a multiportal or a uniportal approach is preferable remains unclear. The aim of this study was to evaluate the safety of implementing uniportal VATS lobectomy into the treatment program of lung cancer patients.

Methods: We used the national quality register for general thoracic surgery in Sweden and included all patients who underwent VATS lobectomy for lung cancer at the Karolinska University Hospital between 2016-2018. Early postoperative complications were compared in patients undergoing uniportal (n=122) and multiportal (n=211) VATS lobectomy for lung cancer. Inverse probability of treatment weighting and standardized mean differences were used to limit differences in baseline characteristics and to assess balance after weighting.

Results: The proportion of uniportal VATS lobectomies increased during the study period and the conversion rates declined significantly. Baseline characteristics were similar in the two groups with the exception of a higher percentage of patients without any comorbidity in the uniportal group (59.8% vs. 44.5%, P=0.010). After inverse probability of treatment weighting the groups were well balanced. Postoperative complications were rare regardless of surgical approach, 94% in both groups had no complications. The 30-day mortality and overall survival at 1 year was 0% and 97% in the uniportal group, and 0.5% and 98% in the multiportal group (P=0.71). Patients undergoing uniportal VATS lobectomy were discharged directly to home to a higher extent than multiportal VATS patients (76.2% vs. 62.1%, P=0.008).

Conclusions: We found that uniportal VATS lobectomy was feasible and safe, and might entail advantages in terms of a faster recovery after surgery as compared to multiportal VATS lobectomy in patients with lung cancer.

Keywords: Uniportal; lobectomy; lung cancer; multiportal; video-assisted thoracic surgery (VATS).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Number of VATS lobectomies performed per year at Karolinska University Hospital 2016–2018. VATS, video-assisted thoracic surgery.
Figure 2
Figure 2
Median number of lymph nodes sampled perioperatively; percentage of patients with chest drain removal on postoperative day one; median postoperative hospital stay in days; proportion of patients discharged directly to home, according to surgical approach. POD 1, postoperative day 1; VATS, video-assisted thoracic surgery.
Figure 3
Figure 3
Survival after uniportal or multiportal VATS lobectomy for lung cancer. Survival is plotted against time after surgery and stratified according to surgical approach, uniportal VATS lobectomy (red line) and multiportal VATS lobectomy (black line). VATS, video-assisted thoracic surgery.
Figure S1
Figure S1
Absolute standardized differences before (hollow circles) and after (filled circles) inverse probability of treatment weighting.
See this image and copyright information in PMC

Comment in

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