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      A Matched Comparison Study of Uniportal Versus Triportal Thoracoscopic Lobectomy and Sublobectomy for Early-stage Nonsmall Cell Lung Cancer

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          Abstract

          Background:

          Both uniportal and triportal thoracoscopic lobectomy and sublobectomy are feasible for early-stage non-small cell lung cancer (NSCLC). The aim of this study was to compare the perioperative outcomes of uniportal and triportal thoracoscopic lobectomy and sublobectomy for early-stage NSCLC.

          Methods:

          A total of 405 patients with lung lesions underwent thoracoscopic lobectomy or sublobectomy through a uniportal or triportal procedure in approximately 7-month period (From November 2014 to May 2015). A propensity-matched analysis, incorporating preoperative variables, was used to compare the short-term outcomes of patients who received uniportal or triportal thoracoscopic lobectomy and sublobectomy.

          Results:

          Fifty-eight patients underwent uniportal and 347 patients underwent triportal pulmonary resection. The conversion rate for uniportal and triportal procedure was 3.4% (2/58) and 2.3% (8/347), respectively. The complication rate for uniportal and triportal procedure was 10.3% and 9.5%, respectively. There was no perioperative death in either group. Most patients had early-stage NSCLC in both groups (uniportal: 45/47, 96%; triportal: 313/343, 91%). Propensity score-matching analysis demonstrated no significant differences in operation time, intraoperative blood loss, numbers of dissected lymph nodes, number of stations of lymph node dissected, duration of chest tube, and complication rate between uniportal and triportal group for early-stage NSCLC. However, the duration of postoperative hospitalization was longer in the uniportal group (6.83 ± 4.17 vs. 5.42 ± 1.86 d, P = 0.036) compared with the triportal group.

          Conclusions:

          Uniportal thoracoscopic lobectomy and sublobectomy is safe and feasible, with comparable short-term outcomes with triportal thoracoscopic pulmonary resection. Uniportal lobectomy and sublobectomy lead to similar cure rate as triportal lobectomy and sublobectomy for early NSCLC.

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          Uniportal video-assisted thoracoscopic lobectomy: two years of experience.

          Lucía Méndez, Eva Trigo, D Rivas … (2013)
          A video-assisted thoracoscopic approach to lobectomy varies among surgeons. Typically, 3 to 4 incisions are made. Our approach has evolved from a 3-port to a 2-port approach to a single 4- to 5-cm incision with no rib spreading. We report results with single-incision video-assisted thoracic major pulmonary resections during our first 2 years of experience. In June 2010, we began performing video-assisted thoracoscopic lobectomies through a uniportal approach (no rib spreading). By July 12, 2012, 102 patients had undergone this single-incision approach. Of 102 attempted major resections, 97 were successfully completed with a single incision (operations in 3 patients were converted to open surgery and 2 patients needed 1 additional incision). Five uniportal pneumonectomies were not included in the study. We have analyzed early outcomes of successful uniportal lobectomies (92 patients studied). Right upper lobectomy was the most frequent resection (28 cases). Mean surgical time was 154.1 ± 46 minutes (range, 60-310 minutes), mean number of lymph nodes was 14.5 ± 7 (range, 5-38 nodes), and mean number of explored nodal stations was 4.6 ± 1.2 (range, 3-8 stations). The mean tumor size was 2.8 ± 1.5 cm (0-6.5 cm). The median duration of time a chest tube was in place was 2 days and the median length of hospital stay was 3 days. There were complications in 14 patients; no postoperative 30-day mortality was reported. Single-incision video-assisted thoracoscopic anatomic resection is a feasible and safe procedure with good perioperative results, especially when performed by surgeons experienced with the double-port technique and anterior thoracotomy. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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            VATS lobectomy has better perioperative outcomes than open lobectomy: CALGB 31001, an ancillary analysis of CALGB 140202 (Alliance).

            Chukwumere Nwogu, Jonathan D’Cunha, Herbert Pang … (2015)
            The short-term superiority of video-assisted thoracoscopic surgery lobectomy compared with open lobectomy for early-stage lung cancer has been suggested by single-institution studies. Lack of equipoise limits the feasibility of a randomized study to confirm this. The hypothesis of this study (CALGB 31001) was that VATS lobectomy results in shorter length of hospital stay and fewer complications compared with open lobectomy in stages I and II non-small cell lung cancer in a multi-institutional setting.
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              Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy for small-sized stage IA lung cancer.

              Chenxi Zhong, Wentao Fang, Teng Mao … (2012)
              Thoracoscopic lobectomy for lung cancer has been widely accepted, but thoracoscopic segmentectomy remains controversial because of the complexity of the procedure and of the fear of increased local recurrence. This study compared outcomes between thoracoscopic segmentectomy and thoracoscopic lobectomy in patients with small-sized (≤2 cm) stage IA non-small cell lung cancer. Between March 2006 and August 2011, 39 thoracoscopic segmentectomies and 81 thoracoscopic lobectomies were performed in 120 patients with small-sized (≤2 cm) stage IA lung cancer. Clinicopathologic factors, local recurrence rate, and survival rate were compared. The two groups were similar in age, sex, pulmonary function, and tumor size. There were no conversions from video-assisted thoracoscopic surgery to open or from segmentectomy to lobectomy. There were no in-hospital deaths. The two groups had a similar incidence of postoperative complications. Local recurrence rates were similar after thoracoscopic segmentectomy (5.1%) and thoracoscopic lobectomy (4.9%). No significant difference was observed in 5-year overall or disease-free survivals after thoracoscopic segmentectomy or thoracoscopic lobectomy. Multivariate Cox regression analyses showed tumor size was the only independent prognostic factor for disease-free survival. Thoracoscopic segmentectomy is a safe option and provides comparable oncologic results to thoracoscopic lobectomy for small (≤2 cm) peripheral stage IA non-small cell lung cancer. Tumor size is an independent prognostic factor of disease-free survival for stage IA patients with small-sized lesions. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Chin Med J (Engl)
                Journal ID (iso-abbrev): Chin. Med. J
                Journal ID (publisher-id): CMJ
                Title: Chinese Medical Journal
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0366-6999
                Publication date (Print): 20 October 2015
                Volume: 128
                Issue: 20
                Pages: 2731-2735
                Affiliations
                [1]Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
                Author notes
                Address for correspondence: Prof. Jie He, Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China E-Mail: hejie@ 123456cicams.ac.cn
                Article
                Publisher ID: CMJ-128-2731
                DOI: 10.4103/0366-6999.167298
                PMC ID: 4736897
                PubMed ID: 26481738
                SO-VID: 244aecb6-2f84-4046-b7ad-6fccacdf50d6
                Copyright © Copyright: © 2015 Chinese Medical Journal
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Date received : 18 June 2015
                Categories
                Subject: Original Article

                Keywords: early-stage nonsmall cell lung cancer,lobectomy,sublobectomy,uniportal,video-assisted thoracoscopic surgery
                Data availability:
                Keywords: early-stage nonsmall cell lung cancer, lobectomy, sublobectomy, uniportal, video-assisted thoracoscopic surgery

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