Uniportal video-assisted versus open pneumonectomy: a propensity score-matched comparative analysis with short-term outcomes

Abstract

Uniportal (U-VATS) pneumonectomy in lung cancer patients remains disputed in terms of oncological outcomes, and has not been compared to open approaches previously. We evaluated U-VATS versus open pneumonectomy at a high-volume centre. Patients undergoing pneumonectomy for lung cancer between 2014 and 2018 were retrospectively reviewed and divided into two groups based on surgical approach. Propensity-score matching was performed (1:1), and intention-to-treat analysis applied. Overall survival, operative time, intraoperative blood loss, hospital-stay and readmission, pain, time to adjuvant therapy, morbidity and mortality were tested. Statistical analysis was performed using SAS version 9.4 (SAS Institute Inc. NC) 341 patients underwent pneumonectomy; 23 patients with small-cell lung cancer were excluded, thus 318 patients were submitted to surgery by either U-VATS (n\u2009=\u200954) or open (n\u2009=\u2009264). After matching, 52 patients were selected from each group. Five patients (9.2%) in the uniportal group required conversion. There was no significant difference in intraoperative outcomes, complication rates, readmission rates or mortality. The U-VATS group experienced significantly shorter hospital stay (mean\u2009±\u2009SD; 6.7\u2009±\u20092.7 vs 9.1\u2009±\u20092.3 days, p\u2009<\u20090.001) and reported less pain postoperatively (p\u2009<\u20090.0001). Adjuvant chemotherapy was initiated sooner after U-VATS (38.1\u2009±\u20098.4 vs 50.8\u2009±\u200911.5 days, p\u2009<\u20090.0001). Overall survival appeared to be superior in U-VATS when pathology stage was aligned (p\u2009=\u20090.001). Uniportal VATS is a safe and effective alternative approach to open surgery for pneumonectomy in lung cancer. Complications and oncologic outcomes were comparatively similar. U-VATS showed lower postoperative pain, shorter hospital stay and superior overall survival. The study is a preliminary analysis.