Uniportal versus Multiportal VATS for the Treatment of Lung Cancer David Zeltsman, MD, Stevan S. Pupovac MD, Ariel Aminov BA and Michael Varrone BS
Background
Anticipated Results
Anticipated Conclusions
In the past, the gold standard treatment for lung cancer was a lobectomy via a thoracotomy. The introduction of video-assisted thoracic surgery (VATS) was first described in the early 1990s and has gained popularity at the turn of st the 21 century. VATS is minimally invasive compared to thoracotomy and has demonstrated no significant difference in 5-year survival rates. Furthermore, VATS was associated with fewer complications and shorter hospital stays. These complications include intraoperative bleeding, prolonged air leak, return to OR for bleeding and new onset atrial fibrillation1. While the reduction of complications has been demonstrated in multiportal VATS versus a thoracotomy, there are currently no studies comparing the benefits of uniportal VATS versus multiportal VATS.
From January 2009 and December 2014 , ~800 patients underwent an attempt at uni-portal VATS lobectomy. Thirty-day mortality for the entire cohort was X.X% (X deaths), not significantly different between uni-portal and multi-portal groups. 5-year estimated survival by Cox model was no different for uni-portal VATS versus multiport VATS (hazard ratio X.XX). Patients undergoing VATS lobectomy demonstrated an X-day shorter length of stay than patients undergoing multiport VATS (P<.XXXX).
Uniportal VATS lobectomy and multiportal VATS lobectomy demonstrated similar 5-year survivals. However, uniportal VATS lobectomy was associated with shorter length of hospital stay.
Resources 1. Flores R, Park B, Dycoco J et al. Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer. J Thorac Cardiovasc Surg. 2009;138(1):11-18. doi:10.1016/j.jtcvs.2009.03.030 2. Han K, Kim H, Choi Y. Uniportal video-assisted thoracoscopic surgical (VATS) segmentectomy with preoperative dual localization: right upper lobe wedge resection and left upper lobe upper division segmentectomy. ASVIDE. 2016;3:234234. doi:10.21037/asvide.2016.234
Hypothesis
The use of uniportal VATS will result in equal survival rates and shorter hospital stays compared to multiportal VATS in the treatment of lung cancer.
Methods A retrospective review of a prospectively maintained database was undertaken of all consecutive patients who underwent uniportal VATS lobectomy for clinical stage Ia, defined by computer tomography and positron emission tomography, between January 2009 and December 2014. Operative data as well as short- and long-term outcomes were subsequently analyzed. Survival was determined by the national death index, and subsequently was assessed by Kaplan–Meier and Cox proportional hazards analysis and were compared to gold-standard multiportal VATS.
Figure 1: Instrumentation during uniportal videoassisted thoracoscopic surgery (VATS) 2 segmentectomy under real-time C-arm guidance .