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

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Abstract

Objectives

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.

Methods

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)

Results

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 = 54) or open (n = 264). 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 ± SD; 6.7 ± 2.7 vs 9.1 ± 2.3 days, p < 0.001) and reported less pain postoperatively (p < 0.0001). Adjuvant chemotherapy was initiated sooner after U-VATS (38.1 ± 8.4 vs 50.8 ± 11.5 days, p < 0.0001). Overall survival appeared to be superior in U-VATS when pathology stage was aligned (p = 0.001).

Conclusions

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.

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Acknowledgements

We acknowledge the help of Dr. Simon Turner (Fellowship program Director/University of Alberta-Canada) for revising the manuscript and Dr. Hamzeh Albaba (Jack Ady Cancer Cenrter) for his help in formatting the tables.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, 507 Zhengmin Road, Shanghai, 200433, China

    Samer Al Sawalhi, Haomin Cai, Lantao Zhao, Jacopo Vannucci, Edward J. Caruana, Diego Gonzalez-Rivas & Deping Zhao

  2. Foundation Programme, University Hospitals of Derby and Burton NHS Trust, Derby, UK

    Savannah Gysling

  3. Department of Thoracic Surgery, King Hussein Medical Center, Amman, Jordan

    Hani Alhadidi

  4. Department of Biostatistics and Research Unit, King Hussein Cancer Center, Amman, Jordan

    Dalia Al Rimawi

  5. Department of Thoracic Surgery, Policlinico Umberto I, University of Rome Sapienza, Rome, Italy

    Jacopo Vannucci

  6. Department of Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK

    Edward J. Caruana

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  1. Samer Al Sawalhi
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  2. Savannah Gysling
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  3. Haomin Cai
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  4. Lantao Zhao
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  5. Hani Alhadidi
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  6. Dalia Al Rimawi
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  7. Jacopo Vannucci
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  8. Edward J. Caruana
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  9. Diego Gonzalez-Rivas
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  10. Deping Zhao
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Corresponding author

Correspondence to Deping Zhao.

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Conflict of interest

Dr. Samer Al Sawalhi, Savannah Gysling, Dr. Haomin Cai, Dr.Lantao Zhao, Dr. Hani Alhadidi, Dalia Al Rimawi, Dr. Jacopo Vannucci MD, Dr. Edward Caruana, Dr. Diego Gonzalez-Rivas, Dr. Deping Zhao MD, have no conflicts of interest or financial ties to disclose.

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Al Sawalhi, S., Gysling, S., Cai, H. et al. Uniportal video-assisted versus open pneumonectomy: a propensity score-matched comparative analysis with short-term outcomes. Gen Thorac Cardiovasc Surg 69, 1291–1302 (2021). https://doi.org/10.1007/s11748-021-01626-0

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  • DOI: https://doi.org/10.1007/s11748-021-01626-0

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