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.

Uniportal video-assisted versus open pneumonectomy: a propensity score-matched comparative analysis with short-term outcomes / Al Sawalhi, Samer; Gysling, Savannah; Cai, Haomin; Zhao, Lantao; Alhadidi, Hani; Al Rimawi, Dalia; Vannucci, Jacopo; Caruana, Edward J; Gonzalez-Rivas, Diego; Zhao, Deping. - In: GENERAL THORACIC AND CARDIOVASCULAR SURGERY. - ISSN 1863-6705. - 69:9(2021), pp. 1291-1302. [10.1007/s11748-021-01626-0]

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

Vannucci, Jacopo;
2021

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.
2021
lung cancer; minimally invasive; pneumonectomy; uniportal; video-assisted thoracic surgery (VATS); humans; propensity score; retrospective studies; thoracic surgery, video-assisted; lung neoplasms; pneumonectomy
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Uniportal video-assisted versus open pneumonectomy: a propensity score-matched comparative analysis with short-term outcomes / Al Sawalhi, Samer; Gysling, Savannah; Cai, Haomin; Zhao, Lantao; Alhadidi, Hani; Al Rimawi, Dalia; Vannucci, Jacopo; Caruana, Edward J; Gonzalez-Rivas, Diego; Zhao, Deping. - In: GENERAL THORACIC AND CARDIOVASCULAR SURGERY. - ISSN 1863-6705. - 69:9(2021), pp. 1291-1302. [10.1007/s11748-021-01626-0]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1660545
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