Perioperative outcomes of uniportal versus three-port video-assisted thoracoscopic lobectomy for 2 112 lung cancer patients: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Jian , PU Qiang , MEI Jiandong , MA Lin , LIN Feng , LIU Chengwu , GUO Chenglin , LIAO Hu , ZHU Yunke , ZHENG Quan , LI Zongyuan , WU Dongsheng , CHE Guowei , WANG Yun , LIN Yidan , KOU Yingli , YUAN Yong , HU Yang , WU Zhu ,  LIU Lunxu

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

LIU Lunxu, Email: lunxu_liu@aliyun.com

Keywords：

Uniportal; video-assisted thoracic surgery; three-port; lobectomy; lung cancer; surgical treatment

DOI：

10.7507/1007-4848.202108067

Video：

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Objective To analyze the perioperative outcomes of uniportal thoracoscopic lobectomy compared with three-port thoracoscopic lobectomy. Methods Data were extracted from the Western China Lung Cancer Database, a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University. Perioperative outcomes of the patients who underwent uniportal or three-port thoracoscopic lobectomy for lung cancer during January 2014 through April 2021 were analyzed by using propensity score matching. Altogether 5 817 lung cancer patients were enrolled who underwent thoracoscopic lobectomy (uniportal: 530 patients; three-port: 5 287 patients). After matching, 529 patients of uniportal and 1 583 patients of three-port were included. There were 529 patients with 320 males and 209 females at median age of 58 (51, 65) years in the uniportal group and 1 583 patients with 915 males and 668 females at median age of 58 (51, 65) years in the three-port group. Results Uniportal thoracoscopic lobectomy was associated with less intraoperative blood loss (20 mL vs. 30 mL, P<0.001), longer operative time (115 min vs. 105 min, P<0.001) than three-port thoracoscopic lobectomy. No significant difference was found between the two groups regarding the number of lymph node dissected, rate of conversion to thoracotomy, incidence of postoperative complication, postoperative pain score within 3 postoperative days, length of hospital stay, or hospitalization expenses. Conclusion Uniportal video-assisted thoracoscopic lobectomy is safe and effective, and the overall perioperative outcomes are comparable between uniportal and three-port strategies, although the two groups show differences in intraoperative blood loss.

Citation： ZHOU Jian, PU Qiang, MEI Jiandong, MA Lin, LIN Feng, LIU Chengwu, GUO Chenglin, LIAO Hu, ZHU Yunke, ZHENG Quan, LI Zongyuan, WU Dongsheng, CHE Guowei, WANG Yun, LIN Yidan, KOU Yingli, YUAN Yong, HU Yang, WU Zhu, LIU Lunxu. Perioperative outcomes of uniportal versus three-port video-assisted thoracoscopic lobectomy for 2 112 lung cancer patients: A propensity score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(9): 1005-1011. doi: 10.7507/1007-4848.202108067 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	廖虎, 梅建东, 刘成武, 等. 中国三级医院胸外科学科临床发展现状的调查研究. 中华外科杂志, 2018, 56(12): 888-891.
3.	Klapper J, D'Amico TA. VATS versus open surgery for lung cancer resection: Moving toward a minimally invasive approach. J Natl Compr Canc Netw, 2015, 13(2): 162-164.
4.	Ceppa DP, Kosinski AS, Berry MF, et al. Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: A Society of Thoracic Surgeons Database analysis. Ann Surg, 2012, 256(3): 487-493.
5.	Hernandez-Vaquero D, Vigil-Escalera C, Pérez-Méndez I, et al. Survival after thoracoscopic surgery or open lobectomy: Systematic review and meta-analysis. Ann Thorac Surg, 2021, 111(1): 302-313.
6.	Aiolfi A, Nosotti M, Micheletto G, et al. Pulmonary lobectomy for cancer: Systematic review and network meta-analysis comparing open, video-assisted thoracic surgery, and robotic approach. Surgery, 2021, 169(2): 436-446.
7.	Abbas AE. Surgical management of lung cancer: History, evolution, and modern advances. Curr Oncol Rep, 2018, 20(12): 98.
8.	Wang L, Liu D, Lu J, et al. The feasibility and advantage of uniportal video-assisted thoracoscopic surgery (VATS) in pulmonary lobectomy. BMC Cancer, 2017, 17(1): 75.
9.	Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
10.	Gonzalez D, Paradela M, Garcia J, et al. Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg, 2011, 12(3): 514-515.
11.	Liu CC, Shih CS, Pennarun N, et al. Transition from a multiport technique to a single-port technique for lung cancer surgery: Is lymph node dissection inferior using the single-port technique? Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i64-i72.
12.	Perna V, Carvajal AF, Torrecilla JA, et al. Uniportal video-assisted thoracoscopic lobectomy versus other video-assisted thoracoscopic lobectomy techniques: A randomized study. Eur J Cardiothorac Surg, 2016, 50(3): 411-415.
13.	Tong Y, Wei P, Wang S, et al. Characteristics of postoperative pain after VATS and pain-related factors: The experience in National Cancer Center of China. J Pain Res, 2020, 13: 1861-1867.
14.	刘伦旭, 车国卫, 蒲强, 等. 单向式全胸腔镜肺叶切除术. 中华胸心血管外科杂志, 2008, 24(3): 156-158.
15.	Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy. Surg Oncol, 2010, 19(2): e71-e77.
16.	Network NCC. NCCN clinical practice guidelines in oncology. Non-small cell lung cancer, Version 5. 2021.https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. Published 2021. Accessed.
17.	支修益, 刘伦旭. 中国胸外科围手术期气道管理指南(2020 版). 中国胸心血管外科临床杂志, 2021, 28(3): 251-262.
18.	Fernandez FG, Falcoz PE, Kozower BD, et al. The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases: Joint standardization of variable definitions and terminology. Ann Thorac Surg, 2015, 99(1): 368-376.
19.	Wang BY, Liu CY, Hsu PK, et al. Single-incision versus multiple-incision thoracoscopic lobectomy and segmentectomy: A propensity-matched analysis. Ann Surg, 2015, 261(4): 793-799.
20.	Benedetto U, Head SJ, Angelini GD, et al. Statistical primer: Propensity score matching and its alternatives. Eur J Cardiothorac Surg, 2018, 53(6): 1112-1117.
21.	Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med, 2009, 28(25): 3083-3107.
22.	Kirby TJ, Mack MJ, Landreneau RJ, et al. Initial experience with video-assisted thoracoscopic lobectomy. Ann Thorac Surg, 1993, 56(6): 1248-1252.
23.	Lewis RJ. The role of video-assisted thoracic surgery for carcinoma of the lung: Wedge resection to lobectomy by simultaneous individual stapling. Ann Thorac Surg, 1993, 56(3): 762-768.
24.	Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol, 2009, 27(15): 2553-2562.
25.	Onaitis MW, Petersen RP, Balderson SS, et al. Thoracoscopic lobectomy is a safe and versatile procedure: Experience with 500 consecutive patients. Ann Surg, 2006, 244(3): 420-425.
26.	Swanson SJ, Herndon JE 2nd, D'Amico TA, et al. Video-assisted thoracic surgery lobectomy: Report of CALGB 39802—A prospective, multi-institution feasibility study. J Clin Oncol, 2007, 25(31): 4993-4997.
27.	支修益, 陈东红. 非小细胞肺癌外科治疗现状和进展. 首都医科大学学报, 2009, 30(3): 298-305.
28.	McKenna RJ, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: Experience with 1,100 cases. Ann Thorac Surg, 2006, 81(2): 421-426.
29.	Gonzalez-Rivas D, Paradela M, Fieira E, et al. Single-incision video-assisted thoracoscopic lobectomy: Initial results. J Thorac Cardiovasc Surg, 2012, 143(3): 745-747.
30.	Gonzalez-Rivas D, Paradela M, Fernandez R, et al. Uniportal video-assisted thoracoscopic lobectomy: Two years of experience. Ann Thorac Surg, 2013, 95(2): 426-432.
31.	McElnay PJ, Molyneux M, Krishnadas R, et al. Pain and recovery are comparable after either uniportal or multiport video-assisted thoracoscopic lobectomy: An observation study. Eur J Cardiothorac Surg, 2015, 47(5): 912-915.
32.	朱云柯, 林琳, 廖虎, 等. 中国胸外科围手术期疼痛管理专家共识(2018 版). 中国胸心血管外科临床杂志, 2018, 25(11): 921-928.
33.	Hirai K, Takeuchi S, Usuda J. Single-incision thoracoscopic surgery and conventional video-assisted thoracoscopic surgery: A retrospective comparative study of perioperative clinical outcomes. Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i37-i41.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 廖虎, 梅建东, 刘成武, 等. 中国三级医院胸外科学科临床发展现状的调查研究. 中华外科杂志, 2018, 56(12): 888-891.
3. Klapper J, D'Amico TA. VATS versus open surgery for lung cancer resection: Moving toward a minimally invasive approach. J Natl Compr Canc Netw, 2015, 13(2): 162-164.
4. Ceppa DP, Kosinski AS, Berry MF, et al. Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: A Society of Thoracic Surgeons Database analysis. Ann Surg, 2012, 256(3): 487-493.
5. Hernandez-Vaquero D, Vigil-Escalera C, Pérez-Méndez I, et al. Survival after thoracoscopic surgery or open lobectomy: Systematic review and meta-analysis. Ann Thorac Surg, 2021, 111(1): 302-313.
6. Aiolfi A, Nosotti M, Micheletto G, et al. Pulmonary lobectomy for cancer: Systematic review and network meta-analysis comparing open, video-assisted thoracic surgery, and robotic approach. Surgery, 2021, 169(2): 436-446.
7. Abbas AE. Surgical management of lung cancer: History, evolution, and modern advances. Curr Oncol Rep, 2018, 20(12): 98.
8. Wang L, Liu D, Lu J, et al. The feasibility and advantage of uniportal video-assisted thoracoscopic surgery (VATS) in pulmonary lobectomy. BMC Cancer, 2017, 17(1): 75.
9. Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
10. Gonzalez D, Paradela M, Garcia J, et al. Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg, 2011, 12(3): 514-515.
11. Liu CC, Shih CS, Pennarun N, et al. Transition from a multiport technique to a single-port technique for lung cancer surgery: Is lymph node dissection inferior using the single-port technique? Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i64-i72.
12. Perna V, Carvajal AF, Torrecilla JA, et al. Uniportal video-assisted thoracoscopic lobectomy versus other video-assisted thoracoscopic lobectomy techniques: A randomized study. Eur J Cardiothorac Surg, 2016, 50(3): 411-415.
13. Tong Y, Wei P, Wang S, et al. Characteristics of postoperative pain after VATS and pain-related factors: The experience in National Cancer Center of China. J Pain Res, 2020, 13: 1861-1867.
14. 刘伦旭, 车国卫, 蒲强, 等. 单向式全胸腔镜肺叶切除术. 中华胸心血管外科杂志, 2008, 24(3): 156-158.
15. Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy. Surg Oncol, 2010, 19(2): e71-e77.
16. Network NCC. NCCN clinical practice guidelines in oncology. Non-small cell lung cancer, Version 5. 2021.https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. Published 2021. Accessed.
17. 支修益, 刘伦旭. 中国胸外科围手术期气道管理指南(2020 版). 中国胸心血管外科临床杂志, 2021, 28(3): 251-262.
18. Fernandez FG, Falcoz PE, Kozower BD, et al. The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases: Joint standardization of variable definitions and terminology. Ann Thorac Surg, 2015, 99(1): 368-376.
19. Wang BY, Liu CY, Hsu PK, et al. Single-incision versus multiple-incision thoracoscopic lobectomy and segmentectomy: A propensity-matched analysis. Ann Surg, 2015, 261(4): 793-799.
20. Benedetto U, Head SJ, Angelini GD, et al. Statistical primer: Propensity score matching and its alternatives. Eur J Cardiothorac Surg, 2018, 53(6): 1112-1117.
21. Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med, 2009, 28(25): 3083-3107.
22. Kirby TJ, Mack MJ, Landreneau RJ, et al. Initial experience with video-assisted thoracoscopic lobectomy. Ann Thorac Surg, 1993, 56(6): 1248-1252.
23. Lewis RJ. The role of video-assisted thoracic surgery for carcinoma of the lung: Wedge resection to lobectomy by simultaneous individual stapling. Ann Thorac Surg, 1993, 56(3): 762-768.
24. Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol, 2009, 27(15): 2553-2562.
25. Onaitis MW, Petersen RP, Balderson SS, et al. Thoracoscopic lobectomy is a safe and versatile procedure: Experience with 500 consecutive patients. Ann Surg, 2006, 244(3): 420-425.
26. Swanson SJ, Herndon JE 2nd, D'Amico TA, et al. Video-assisted thoracic surgery lobectomy: Report of CALGB 39802—A prospective, multi-institution feasibility study. J Clin Oncol, 2007, 25(31): 4993-4997.
27. 支修益, 陈东红. 非小细胞肺癌外科治疗现状和进展. 首都医科大学学报, 2009, 30(3): 298-305.
28. McKenna RJ, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: Experience with 1,100 cases. Ann Thorac Surg, 2006, 81(2): 421-426.
29. Gonzalez-Rivas D, Paradela M, Fieira E, et al. Single-incision video-assisted thoracoscopic lobectomy: Initial results. J Thorac Cardiovasc Surg, 2012, 143(3): 745-747.
30. Gonzalez-Rivas D, Paradela M, Fernandez R, et al. Uniportal video-assisted thoracoscopic lobectomy: Two years of experience. Ann Thorac Surg, 2013, 95(2): 426-432.
31. McElnay PJ, Molyneux M, Krishnadas R, et al. Pain and recovery are comparable after either uniportal or multiport video-assisted thoracoscopic lobectomy: An observation study. Eur J Cardiothorac Surg, 2015, 47(5): 912-915.
32. 朱云柯, 林琳, 廖虎, 等. 中国胸外科围手术期疼痛管理专家共识(2018 版). 中国胸心血管外科临床杂志, 2018, 25(11): 921-928.
33. Hirai K, Takeuchi S, Usuda J. Single-incision thoracoscopic surgery and conventional video-assisted thoracoscopic surgery: A retrospective comparative study of perioperative clinical outcomes. Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i37-i41.

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