Abstract
BackgroundUniportal video-assisted thoracoscopic surgery (U-VATS) has recently emerged as an alternative procedure for non-small cell lung cancer (NSCLC); however, whether U-VATS has advantages over multiportal VATS (M-VATS) remains unknown.MethodsWe performed a systematic review of two databases (Pubmed and Web of Science) to search comparative studies of U-VATS and M-VATS anatomical pulmonary resection for NSCLC. Operative time, blood loss, number of resected lymph nodes, drainage duration, length of postoperative stay, pain in postoperative day 1(POD1) and conversion rates were retrieved to estimate the comparison of outcomes. A subgroup analysis stratified by study type (propensity-matched analysis and randomized-controlled trial versus non-propensity matched analysis) was performed.ResultA total of 20 studies with 4142 patients were included in this meta-analysis. U-VATS was performed on 1869 patients, whereas the other 2173 patients underwent M-VATS. This meta-analysis showed that there was no significant difference in operative time (U-VATS: 146.48 ± 55.07 min versus M-VATS: 171.70 ± 79.40 min, P = 0.81), blood loss (74.49 ± 109.03 mL versus 95.48 ± 133.67 mL, P = 0.18), resected lymph nodes (17.28 ± 9.46 versus 18.31 ± 10.17, P = 0.62), conversion rate (6.18% versus 4.34%, P = 0.14), drainage duration (3.90 ± 2.94 days versus 4.44 ± 3.12 days, p = 0.09), length of postoperative stay (6.16 ± 4.40 days versus 6.45 ± 4.80 days, P = 0.22), and pain in POD1 (3.94 ± 1.68 versus 3.59 ± 2.76, p = 0.07). Subgroup analysis showed the value of PSM and RCT group consistency with overall value.ConclusionThis up-to-date meta-analysis shows that the perioperative outcomes of U-VATS and M-VATS anatomical pulmonary resection are equivalent. In addition, the differences in long-term outcomes of these two approaches are still unclear. Thoracic surgeons should pay more emphasize on providing high-quality and personalized surgical care for patients, to improve the survival ultimately.
Highlights
Uniportal video-assisted thoracoscopic surgery (U-VATS) has recently emerged as an alternative procedure for non-small cell lung cancer (NSCLC); whether U-VATS has advantages over multiportal VATS (M-VATS) remains unknown
Studies that comply with the following criteria were included in this meta-analysis: (1) An unmatched or propensity score matched comparison between U-VATS and M-VATS anatomical pulmonary resection; (2) Included at least one of the following outcomes was reported: operative time, resected lymph nodes, drainage duration, blood loss, length of postoperative stay (LOS), and pain in postoperative day 1 (POD 1); (3) Focused on NSCLC; (4) Published full text article; (5) Written in English
The present meta-analysis revealed that there was no significant difference between U-VATS group and M-VATS group (SMD = -0.04, 95%confidence intervals (CI) = (− 0.33, 0.26), P = 0.81, Fig. 2a)
Summary
Uniportal video-assisted thoracoscopic surgery (U-VATS) has recently emerged as an alternative procedure for non-small cell lung cancer (NSCLC); whether U-VATS has advantages over multiportal VATS (M-VATS) remains unknown. Since the first pneumonectomy was performed for a patient with non-small cell lung cancer (NSCLC) in 1933, surgery is one of the main treatment methods for NSCL C [1]. The past decades have witnessed continuous evolution and progress of surgical techniques, such as the utilization of segmentectomy and the development of video-assisted thoracoscopic surgery (VATS). Uniportal minimally invasive surgery has developed rapidly since Dr Rocco first reported in 2004, expanding from the minor thoracic procedures such as wedge resection to complex operations such as lobectomy, segmentectomy, and even bronchial or pulmonary angioplasty [5]
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