P2.16-04 Single-Port Video-Assisted Thoracoscopic Surgery Reduces Patient-Reported Symptom Burden in Patients Undergoing Lung Resection

Abstract

Symptom relief has been considered one of the most important targets in recovery from a surgery. This study aimed to evaluate the advantages of single-port video-assisted thoracoscopic surgery (VATS) in reducing postoperative symptom burden, by comparison with multi-port VATS in patients undergoing lung resection. Data were collected from an ongoing, real-world, multicenter, prospective, observational study initiated in November 2017 (NCT03341377). The MD Anderson Symptom Inventory for lung cancer (MDASI-LC) was administered to assess the severity of postoperative symptoms and their interference with daily functioning preoperatively and daily postoperatively until discharge. A symptom burden index (MDASI-SI) was generated by averaging the top 5 severe symptoms. MDASI-SI was compared between groups using the Wilcoxon rank sum test. The changes of symptoms over hospitalization were compared using mixed modeling. Among 175 patients who underwent lung resection, 89 underwent single-port VATS, 30 two-port VATS, 13 three-port VATS, and 43 four-port VATS. We combined two- and three-port VATS patients due to the small sample size. The top 5 severe symptoms were pain, fatigue, coughing, disturbed sleep, and shortness of breath for all the patients. There were no significant differences between single-, two/three-, and four-port VATS in preoperative MDASI-SI. The median postoperative hospital stay was 6 days for each group. The MDASI-SI scores of single-port VATS (median=3.6; inter quartile range (IQR)=2.4) were significantly lower than those of two/three-port (median=4.6; IQR=2.8; P=0.043) and four-port VATS (median=5.1; IQR=3.3; P=0.0005) on postoperative day (POD) 1. Compared to four-port VATS, patients who underwent single-port VATS experienced significantly lower symptom burden from POD 1 to POD 6 (estimate=-0.77; SE=0.28; P=0.005). This study provided real-world evidence that the single-port VATS has a significant benefit of reducing symptom burden in patients undergoing lung resection during the early postoperative period. The long-term benefit and its impact on patient’s quality of life, adjuvant therapy, and survival need to be investigated in further studies.