P1.08-039 Systematic Review and Updated Meta-Analysis of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery for Lung Cancer

Abstract

Uniportal video-assisted thoracoscopic surgery (VATS) is a challenging surgical procedure that poses substantial technical difficulties compared to multiportal VATS but has been associated with favorable outcomes in studies reported to date. On-line databases were screened until June 2016. Meta-analysis aimed to compare clinical outcomes of uniportal and multiportal VATS lobectomy for patients with lung cancer. Endpoints assessed included perioperative mortality, operative time and blood loss; length of hospital stay; duration of postoperative drainage; rates of conversion to open thoracotomy; number of harvested lymph nodes and overall morbidity. Risk Ratios (RR)/Mean Difference (MD) and corresponding 95% Confidence Intervals (95%CIs) served as primary statistics. Twelve studies were included (among them 1 randomized trial) that enrolled N=2,476 patients. There was no difference in the 30-day mortality: (N=2,476); RR (95%CIs) 0.32 (0.03-3.01); p=0.32; Event rates: 0.10% (1/1,021) vs 0.07% (1/1,455); no difference were demonstrated for conversion-to-thoracotomy: 0.91 (0.48-1.73); p=0.77; similarly there were no differences in regard to operative times: MD (95% CIs): 3.50 ([-12.35]-19.34) min; p=0.67 and blood loss: -2.15 ([-17.13]-12.83) ml; p=0.78. There was no statistically significant difference between number of harvested lymph nodes: 18.4±6.6 vs 19.4±8.5; MD (95%CIs): -0.34 ([-1.39]-0.70) node; p=0.52. Uniportal VATS was associated with significantly shorter duration of chest tube drainage: -0.61 ([-0.99]-[-0.23]) days; p=0.002 (Figure 1A); and length of hospital stay: -0.58 ([-0.77]-[-0.40]) days; p<0.001 (Figure 1B). Overall morbidity was significantly reduced with uniportal VATS as well: RR (95%CIs) 0.77 (0.63-0.95); p=0.01. Uniportal VATS is at least as safe and effective as multiportal VATS for patients with lung cancer. Whether clear postoperative benefits with uniportal VATS further translate into reduction of clinical endpoints and potentially improved survival remains to be confirmed in adequately powered randomized trial.