Mamdoh Al-Ameri1,2, Erik Sachs1,2, Ulrik Sartipy1,2, Veronica Jackson2. 1. Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden. 2. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND: Video-assisted thoracic surgery (VATS) lobectomy is the recommended surgical approach for patients with stage I lung cancer. Whether a multiportal or a uniportal approach is preferable remains unclear. The aim of this study was to evaluate the safety of implementing uniportal VATS lobectomy into the treatment program of lung cancer patients. METHODS: We used the national quality register for general thoracic surgery in Sweden and included all patients who underwent VATS lobectomy for lung cancer at the Karolinska University Hospital between 2016-2018. Early postoperative complications were compared in patients undergoing uniportal (n=122) and multiportal (n=211) VATS lobectomy for lung cancer. Inverse probability of treatment weighting and standardized mean differences were used to limit differences in baseline characteristics and to assess balance after weighting. RESULTS: The proportion of uniportal VATS lobectomies increased during the study period and the conversion rates declined significantly. Baseline characteristics were similar in the two groups with the exception of a higher percentage of patients without any comorbidity in the uniportal group (59.8% vs. 44.5%, P=0.010). After inverse probability of treatment weighting the groups were well balanced. Postoperative complications were rare regardless of surgical approach, 94% in both groups had no complications. The 30-day mortality and overall survival at 1 year was 0% and 97% in the uniportal group, and 0.5% and 98% in the multiportal group (P=0.71). Patients undergoing uniportal VATS lobectomy were discharged directly to home to a higher extent than multiportal VATS patients (76.2% vs. 62.1%, P=0.008). CONCLUSIONS: We found that uniportal VATS lobectomy was feasible and safe, and might entail advantages in terms of a faster recovery after surgery as compared to multiportal VATS lobectomy in patients with lung cancer. 2019 Journal of Thoracic Disease. All rights reserved.
BACKGROUND: Video-assisted thoracic surgery (VATS) lobectomy is the recommended surgical approach for patients with stage I lung cancer. Whether a multiportal or a uniportal approach is preferable remains unclear. The aim of this study was to evaluate the safety of implementing uniportal VATS lobectomy into the treatment program of lung cancer patients. METHODS: We used the national quality register for general thoracic surgery in Sweden and included all patients who underwent VATS lobectomy for lung cancer at the Karolinska University Hospital between 2016-2018. Early postoperative complications were compared in patients undergoing uniportal (n=122) and multiportal (n=211) VATS lobectomy for lung cancer. Inverse probability of treatment weighting and standardized mean differences were used to limit differences in baseline characteristics and to assess balance after weighting. RESULTS: The proportion of uniportal VATS lobectomies increased during the study period and the conversion rates declined significantly. Baseline characteristics were similar in the two groups with the exception of a higher percentage of patients without any comorbidity in the uniportal group (59.8% vs. 44.5%, P=0.010). After inverse probability of treatment weighting the groups were well balanced. Postoperative complications were rare regardless of surgical approach, 94% in both groups had no complications. The 30-day mortality and overall survival at 1 year was 0% and 97% in the uniportal group, and 0.5% and 98% in the multiportal group (P=0.71). Patients undergoing uniportal VATS lobectomy were discharged directly to home to a higher extent than multiportal VATS patients (76.2% vs. 62.1%, P=0.008). CONCLUSIONS: We found that uniportal VATS lobectomy was feasible and safe, and might entail advantages in terms of a faster recovery after surgery as compared to multiportal VATS lobectomy in patients with lung cancer. 2019 Journal of Thoracic Disease. All rights reserved.
Entities:
Keywords:
Uniportal; lobectomy; lung cancer; multiportal; video-assisted thoracic surgery (VATS)
Authors: Erik von Elm; Douglas G Altman; Matthias Egger; Stuart J Pocock; Peter C Gøtzsche; Jan P Vandenbroucke Journal: J Clin Epidemiol Date: 2008-04 Impact factor: 6.437
Authors: Christopher G Harris; Rebecca S James; David H Tian; Tristan D Yan; Mathew P Doyle; Diego Gonzalez-Rivas; Christopher Cao Journal: Ann Cardiothorac Surg Date: 2016-03
Authors: Erik M von Meyenfeldt; Geertruid M H Marres; Eric van Thiel; Ronald A M Damhuis Journal: Eur J Cardiothorac Surg Date: 2018-09-01 Impact factor: 4.191
Authors: P E Postmus; K M Kerr; M Oudkerk; S Senan; D A Waller; J Vansteenkiste; C Escriu; S Peters Journal: Ann Oncol Date: 2017-07-01 Impact factor: 32.976
Authors: Calvin S H Ng; John K MacDonald; Sebastien Gilbert; Ali Z Khan; Young T Kim; Brian E Louie; M Blair Marshall; Ricardo S Santos; Marco Scarci; Yaron Shargal; Hiran C Fernando Journal: Innovations (Phila) Date: 2019-04
Authors: Ju-Wei Mu; Shu-Geng Gao; Qi Xue; Jun Zhao; Ning Li; Kun Yang; Kai Su; Zhu-Yang Yuan; Jie He Journal: Chin Med J (Engl) Date: 2015-10-20 Impact factor: 2.628
Authors: Eric I Benchimol; Liam Smeeth; Astrid Guttmann; Katie Harron; David Moher; Irene Petersen; Henrik T Sørensen; Erik von Elm; Sinéad M Langan Journal: PLoS Med Date: 2015-10-06 Impact factor: 11.069