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. 2021 Sep;69(9):1291-1302.
doi: 10.1007/s11748-021-01626-0. Epub 2021 Apr 25.

Uniportal video-assisted versus open pneumonectomy: a propensity score-matched comparative analysis with short-term outcomes

Samer Al Sawalhi  1 , Savannah Gysling  2 , Haomin Cai  1 , Lantao Zhao  1 , Hani Alhadidi  3 , Dalia Al Rimawi  4 , Jacopo Vannucci  1   5 , Edward J Caruana  1   6 , Diego Gonzalez-Rivas  1 , Deping Zhao  7
Affiliations

Uniportal video-assisted versus open pneumonectomy: a propensity score-matched comparative analysis with short-term outcomes

Samer Al Sawalhi et al. Gen Thorac Cardiovasc Surg. 2021 Sep.

Abstract

Objectives: Uniportal (U-VATS) pneumonectomy in lung cancer patients remains disputed in terms of oncological outcomes, and has not been compared to open approaches previously. We evaluated U-VATS versus open pneumonectomy at a high-volume centre.

Methods: Patients undergoing pneumonectomy for lung cancer between 2014 and 2018 were retrospectively reviewed and divided into two groups based on surgical approach. Propensity-score matching was performed (1:1), and intention-to-treat analysis applied. Overall survival, operative time, intraoperative blood loss, hospital-stay and readmission, pain, time to adjuvant therapy, morbidity and mortality were tested. Statistical analysis was performed using SAS version 9.4 (SAS Institute Inc. NC) RESULTS: 341 patients underwent pneumonectomy; 23 patients with small-cell lung cancer were excluded, thus 318 patients were submitted to surgery by either U-VATS (n = 54) or open (n = 264). After matching, 52 patients were selected from each group. Five patients (9.2%) in the uniportal group required conversion. There was no significant difference in intraoperative outcomes, complication rates, readmission rates or mortality. The U-VATS group experienced significantly shorter hospital stay (mean ± SD; 6.7 ± 2.7 vs 9.1 ± 2.3 days, p < 0.001) and reported less pain postoperatively (p < 0.0001). Adjuvant chemotherapy was initiated sooner after U-VATS (38.1 ± 8.4 vs 50.8 ± 11.5 days, p < 0.0001). Overall survival appeared to be superior in U-VATS when pathology stage was aligned (p = 0.001).

Conclusions: Uniportal VATS is a safe and effective alternative approach to open surgery for pneumonectomy in lung cancer. Complications and oncologic outcomes were comparatively similar. U-VATS showed lower postoperative pain, shorter hospital stay and superior overall survival. The study is a preliminary analysis.

Keywords: Lung cancer; Minimally invasive; Pneumonectomy; Uniportal; Video-assisted thoracic surgery (VATS).

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