Uniportal versus multiportal video-assisted thoracic surgery for lung cancer

Mamdoh Al-Ameri; Erik Sachs; Ulrik Sartipy; Veronica Jackson

doi:10.21037/jtd.2019.12.01

Uniportal versus multiportal video-assisted thoracic surgery for lung cancer

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

Authors

Mamdoh Al-Ameri^{1

2}, Erik Sachs^{1

2}, Ulrik Sartipy^{1

2}, Veronica Jackson²

Affiliations

¹ Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
² Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.

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).