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. 2022 Mar 4:9:840070.
doi: 10.3389/fsurg.2022.840070. eCollection 2022.

Surgical Effectiveness of Uniportal-VATS Lobectomy Compared to Open Surgery in Early-Stage Lung Cancer

Dania Nachira  1 , Maria Teresa Congedo  1 , Diomira Tabacco  1 , Carolina Sassorossi  1 , Giuseppe Calabrese  1 , Mahmoud Ismail  2 , Maria Letizia Vita  1 , Leonardo Petracca-Ciavarella  1 , Stefano Margaritora  1 , Elisa Meacci  1
Affiliations

Surgical Effectiveness of Uniportal-VATS Lobectomy Compared to Open Surgery in Early-Stage Lung Cancer

Dania Nachira et al. Front Surg. .

Abstract

Background: Although the feasibility and safety of Uniportal-Video-Assisted thoracic surgery (U-VATS) has been proven, its surgical effectiveness is still debated. The aim of this study is to assess the equivalence of the U-VATS approach compared with an open technique in terms of surgical (nodal-upstaging, complications, and post-operative results) and short-term survival outcomes.

Methods: The clinical data of patients undergoing lobectomy for NSCLC at our center, from January 2014 to December 2019, were analyzed retrospectively. All patients undergoing open or U-VATS lobectomy with lymphadenectomy for early-stage lung cancer (cT1-T3N0, stages IA-IIB) were included in the study. Only 230 patients satisfied the inclusion criteria. Group bias was reduced through 1:1 propensity score matching, which resulted in 46 patients in each group (open surgery and U-VATS).

Results: The intra- and post-operative mortality were null in both groups. There was no difference in the post-operative complications (p: 1.00) between U-VATS and open lobectomy. There was also no recorded difference in the pathological nodal up-staging [11 (23.9%) after thoracotomy vs. 8 (17.4%) after U-VATS, p: 0.440). The chest tube duration was longer in the open group (p: 0.025), with a higher post-operative pain (p: 0.001). Additionally, the 3-year overall survival (OS) was 78% after U-VATS lobectomy vs. 74% after open lobectomy (p: 0.204), while 3-year disease-specific survival (DSS) was 97 vs. 89% (p: 0.371), respectively. The 3-year disease-free survival (DFS) was 62% in the U-VATS group and 66% in the thoracotomy group, respectively (p: 0.917).

Conclusions: Uniportal-VATS lobectomy for the treatment of early-stage lung cancer seems to be a safe and effective technique with similar surgical and short-term survival outcomes as open surgery, but with lower post-operative pain and shorter in-hospital stay.

Keywords: NSCLC; Uniportal-VATS; disease-free survival (DFS); nodal upstaging; oncological outcomes.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study flow-chart with reasons for patient exclusion.
Figure 2
Figure 2
(A) Placement of endoscopic instruments through Uniportal—Video-Assisted thoracic surgery (VATS) incision. (B) U-VATS surgical view during the left side (station 5, 6) lymphadenectomy.
Figure 3
Figure 3
Kaplain–Meier overall survival (OS) analysis.
Figure 4
Figure 4
Kaplain–Meier disease-specific survival (DSS) analysis.
Figure 5
Figure 5
Kaplan–Meier disease-free survival (DFS) analysis.
See this image and copyright information in PMC

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