Objective To analyze the perioperative outcomes of uniportal thoracoscopic lobectomy compared with three-port thoracoscopic lobectomy. Methods Data were extracted from the Western China Lung Cancer Database, a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University. Perioperative outcomes of the patients who underwent uniportal or three-port thoracoscopic lobectomy for lung cancer during January 2014 through April 2021 were analyzed by using propensity score matching. Altogether 5 817 lung cancer patients were enrolled who underwent thoracoscopic lobectomy (uniportal: 530 patients; three-port: 5 287 patients). After matching, 529 patients of uniportal and 1 583 patients of three-port were included. There were 529 patients with 320 males and 209 females at median age of 58 (51, 65) years in the uniportal group and 1 583 patients with 915 males and 668 females at median age of 58 (51, 65) years in the three-port group. Results Uniportal thoracoscopic lobectomy was associated with less intraoperative blood loss (20 mL vs. 30 mL, P<0.001), longer operative time (115 min vs. 105 min, P<0.001) than three-port thoracoscopic lobectomy. No significant difference was found between the two groups regarding the number of lymph node dissected, rate of conversion to thoracotomy, incidence of postoperative complication, postoperative pain score within 3 postoperative days, length of hospital stay, or hospitalization expenses. Conclusion Uniportal video-assisted thoracoscopic lobectomy is safe and effective, and the overall perioperative outcomes are comparable between uniportal and three-port strategies, although the two groups show differences in intraoperative blood loss.
Objective To investigate the optimal procedure and short-term efficacy of uniportal video-assisted thoracic surgery (U-VATS) lobectomy for lung cancer. Methods The clinical data of 61 patients who underwent lobectomy using U-VATS by the same surgeon between April 2016 and February 2017 were retrospectively analyzed. There were 50?patients (40?males and?10?females, aged 61.4±6.6 years)?with conventional ?procedure.?And there were?60?patients (45?males and?15?females, aged 59.2±9.7 years)?utilizing multiportal thoracoscopic surgery (M-VATS) during this period. Results The baseline characteristics in both groups such as age, gender, body mass index, comorbidity and tumor size were comparable (P>0.05). There was no postoperative mortality or conversion to thoracotomy in the study. The parameters such as operative time, blood loss, harvested lymph nodes, duration of chest tube drainage, and length of postoperative hospital stay were similar in both groups (P>0.05). However, there was a statistical difference in pain score at 12 h after surgery in favor of the U-VATS approach (3.2vs.4.3, P=0.04). Moreover, subgroup analysis indicated that the operation time using single-direction U-VATS was noticeably shorter than that in both conventional U-VATS and M-VATS (76.4 minvs.125.8 minvs.105.6 min, P<0.05). However, further analysis was not performed because of small sample. Conclusion The short-term efficacy of U-VATS lobectomy for lung cancer is noninferior to M-VATS, meanwhile, single-direction U-VATS lobectomy is feasible followed by shortened operative time.
ObjectiveTo investigate the clinical effect of metal supported multi-sided versus ordinary ultra-fine drainage tube in the uniportal video-assisted thoracic surgery (VATS) lower pulmonary lobectomy. MethodsFrom January 2021 to June 2022, the clinical data of patients who underwent uniportal VATS lower lobectomy in our hospital were retrospectively analyzed. According to the different types of ultra-fine drainage tubes used in the surgery, the patients were divided into an experimental group (using multi-sided hole 10F ultra-fine drainage tubes with metal support) and a control group (using ordinary 12F ultra-fine drainage tubes). The clinical data of the two groups were compared. ResultsA total of 190 patients were enrolled, including 108 males and 82 females. There were 90 patients in the experimental group aged 56.60±10.14 years; and 100 patients in the control group aged 57.07±11.04 years. The incidences of postoperative lung infection and pleural effusion in the experimental group were lower than those in the control group, with statistically significant differences (P<0.05). The postoperative visual analogue scale score, the need to adjust the chest drainage tube after the surgery, the need for chest puncture after the surgery, the time of postoperative chest tube removal, and the hospitalization cost were statistically different (P<0.05). There was no statistical difference in the length of postoperative hospital stay or the incidences of postoperative lung leakage, arrhythmia, and atelectasis complications (P>0.05). ConclusionCompared with the ordinary ultra-fine drainage tubes, multi-sided hole ultra-fine drainage tubes with metal support can reduce the incidences of lung infection and pleural effusion complications after the uniportal VATS lower lobectomy, reduce the pain and economic burden, which can be applied in the uniportal VATS lower lobectomy.
ObjectiveTo analyze the surgical outcome of patients with lung cancer using double micro-portal video-assisted thoracic surgery (VATS) technique.MethodsWe retrospectively analyzed the perioperative data of 200 patients with primary lung cancer who underwent successful two micro-portal VATS lobectomy between September 2016 and June 2018 at our unit. There were 125 males and 75 females, aged 61.01±8.71 years. The length of the main operating hole was about 2.0–2.5 cm, the size of the secondary operating hole and the observation hole was 0.5 cm individually. Thus, the total length of the three incisions was 3.0–3.5 cm.ResultsThe mean operating time was 99.18±21.77 min, blood loss was 170.35±105.12 ml, and the mean number of dissected lymph node was 15.82±3.33. The mean volume and duration of chest tube were 446.90±195.32 ml and 3.67±1.85 days. The postoperative hospital stay was 5.54±2.41 days. Only one patient died of pulmonary embolism after surgery. There were 7 patients who were converted to thoracotomy. Postoperative pulmonary infection after lobectomy was found in 8 patients. Postoperative air leak over 5 days was developed in 7 patients.ConclusionThe double micro-portal VATS procedure is a safe and effective strategy for patients with lung cancer, which is associated with decreased surgical trauma and less postoperative pain. This emerging technology may benefit patients by enhancing comfort during their postoperative hospitalization.
ObjectiveTo systematically evaluate the effectiveness and safety of single-incision video-assisted thoracic surgery (VATS) versus conventional multiple ports VATS for lung cancer. MethodsWe searched databases including PubMed, The Cochrane Library (Issue 3, 2016), EMbase, CBM, CNKI and WanFang Data from inception to April 2016, to collect randomized controlled trials (RCTs) and cohort studies comparing single-incision VATS and conventional multiple ports VATS for lung cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. ResultsA total of 9 cohort studies involving 1 318 patients were finally included. The results of meta-analysis showed that: compared with the conventional multiple ports VATS group, the single-incision VATS group had shorter chest drainage time (MD=-0.70, 95%CI -1.38 to -0.02, P=0.04), shorter hospital stay (MD=-0.52, 95%CI -0.91 to -0.14, P=0.007), less amount of intraoperative bleeding (MD=-18.49, 95%CI -33.61 to -3.37, P=0.02), lower VAS score at 1 and 3 days after surgery (MD=-0.32, 95%CI -0.51 to -0.14, P=0.000 7; MD=-0.48, 95%CI -0.58 to -0.38, P < 0.000 01). Meanwhile, there were no statistical differences between both groups in operation time (MD=-3.40, 95%CI -13.65 to 6.85, P=0.52), the postoperative complications (OR=0.91, 95%CI 0.65 to 1.27, P=0.56), the number of lymph node dissection (MD=-0.79, 95%CI -2.35 to 0.77, P=0.32), the total cost (MD=0.47, 95%CI -0.39 to 1.32, P=0.28), the intraoperative conversion rate (OR=0.92, 95%CI 0.44 to 1.93, P=0.82) and VAS score at 7 days after surgery (MD=-1.18, 95%CI -2.42 to 0.07, P=0.06). ConclusionCurrent evidence shows, single-incision VATS is superior in the surgical trauma to conventional multiple ports VATS in the treatment of lung cancer, However, due to the limited quality and quantity of included studies, more large-scale, high-quality studies are needed to verify the above conclusion.
Objective To investigate the efficacy, early and late outcomes of video-assisted thoracic surgery (VATS) for cN0-pN2 lung cancer patients compared to open lobectomy. Methods We retrospectively reviewed 262 out of 1 754 patients’ clinical records with cN0-pN2 lung cancer who underwent VATS or open lobectomy in our center between January 2009 and December 2014. There were 107 patients in a VATS group with 50 males and 57 females at the age of 61.5±10.7 years, and 155 patients in an open lobectomy group consisting of 104 males and 51 females at the age of 59.0±8.7 years. Results There was no statistical difference in patients’ age, pulmonary function, and underlying diseases between two groups. Operation time was shorter in the open lobectomy group than that in the VATS group (P=0.044). Postoperative in-hospital time was shorter in the VATS surgery group than that in the open lobectomy group (P=0.008). There was an obvious difference in tumor’s maximum diameter (P<0.05). As for mediatinal lymph node, there was no statistical difference in station dissected and positive rate. One year overall survival rate was 91.6% in the VATS group and 81.9% in the open group. Three-year overall survival rate was 58.3% in the VATS group and 47.3% in the open lobectomy group (P<0.05). Conclusion VATS can achieve both the thoroughness and feasibility as the same as open surgery and with better early outcomes. The overall survival rate may have more to do with tumor’s maximum diameter, not the operation method. Still, it needs prospective studies to demonstrate this relationship.
ObjectiveTo explore the safety and feasibility of uni-portal video-assisted thoracic surgery (VATS) for the treatment of bronchopulmonary sequestration (BPS). MethodsThe clinical data of BPS patients with surgical resection in Shanghai Pulmonary Hospital from February 2010 to June 2021 were reviewed. The patients were divided into a VATS group and a thoracotomy group according to the operation method. The operation time, intraoperative blood loss, hospital stay and postoperative complication rate were compared between the two groups. The VATS group was subdivided into a uni-portal VATS group and a multi-portal VATS group for subgroup analysis. ResultsFinally 131 patients were enrolled, including 62 males and 69 females with an average age of 39.3±13.2 years. There were 103 patients in the VATS group and 28 patients in the thoracotomy group. A total of 104 patients were diagnosed with left lower BPS, 26 with right lower BPS and 1 with bilateral lower BPS. The main symptom was cough (88 patients, 67.2%). There were 119 patients diagnosed by thoracic enhanced CT before operation. Compared with the thoracotomy group, the operation time was not statistically different (P=0.717), but the blood loss was less, the rate of postoperative complication was lower and hospital stay was shorter in the VATS group (P＜0.05). The rate of conversion to open surgery in the uni-portal VATS group and multi-portal VATS group was 11.8% and 13.5%, respectively. Meanwhile, patients in the uni-portal VATS group had shorter operation time and postoperative hospital stay, less blood loss and lower postoperative complication rate than those in the multi-portal VATS group (P＜0.05). Conclusion In order to improve the rate of diagnosis, the lung enhanced CT scan should be selected as an optimal noninvasive method in adult suspected patients (especially those with solid cystic and solid lesions in the lower lobe). Uni-portal VATS is a safe and feasible method for BPS which can be widely promoted.
Objective To compare the subaxillary small incision thoracotomy (SSIT) with video-assisted thoracic surgery (VATS) for patients with lung cancer. Methods Retrospective analysis of 142 patients with lung cancer in Department of Thoracic Surgery, The First People's Hospital of Neijiang from January 2014 to April 2016 was conducted. There were 86 males and 56 females, aged 40-77 years. Patients were divided into a VATS group (n=72) and a SSIT group (n=70). The following postoperative data were evaluated: operation time, number of dissected lymph nodes, intraoperative bleeding, postoperative chest drainage volume, drainage duration, postoperative ambulation time, average hospital stay, postoperative complications, hospitalization cost, early postoperative incision pain (visual analogue scale, VAS) and other indicators. Results There were no statistically significant differences between the two groups in the operation time (120.8±20.4 minvs. 126.2±21.6 min,P=0.124), the dissected lymph node (11.1±2.0vs. 11.4±1.9,P=0.333) and the postoperative complications rate (13.9% vs. 15.7%, P=0.759). Laparoscopic intraoperative bleeding and postoperative drainage volume were significantly less in the VATS group than those in the SSIT group (123.2±26.9 mlvs. 156.4±24.0 ml,P<0.001; 227.0±75.5 mlvs. 334.3±89.1 ml,P<0.001). Postoperative drainage duration, postoperative ambulation time and hospital stay were shorter in the VATS group than those in the SSIT group (2.5±0.5 dvs. 3.1±0.6 d, 1.5±0.5 dvs. 2.2±0.6 d, 6.5±0.5 dvs. 7.4±0.6 d, allP<0.001). The average hospitalization cost of the VATS group was significantly higher than that of the SSIT group (42 338.9±8 855.7 yuanvs. 32 043.7±7 178.1 yuan,P<0.001). There was no significant difference in the operation cost and anesthesia cost between the two groups (P>0.05). The early postoperative pain of laparoscopic group was less, but the difference was not statistically significant (P>0.05). Conclusion The hospitalization cost of the SSIT is lower than that of thoracic surgery, which may be beneficial to the appilication in primary hospitals.
Objective To evaluate the effectiveness and safety of single-incision video-assisted thoracic surgery versus conventional multiple ports video-assisted thoracic surgery in the treatment of lung cancer as well as providing reference for clinical decision-making. Methods We searched the Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP, Wanfang ect until March 2017 to collect randomized controlled trials (RCTs), cohort studies, and case-control studies comparing single-incision with conventional multiple ports video-assisted thoracic surgery for lung cancer.Two reviewers independently screened and selected literatures according to inclusion and exclusion criteria. Then data extraction and quality assessment of included studies were conducted. RevMan 5.3 software was used for meta-analysis. Results Twenty-six cohort studies (3 053 patients) were included. The quality of the included studies was high with score more than five.Meta-analysis showed that single-incision video-assisted thoracic surgery had shorter thoracic drainage time (MD=–0.71, 95% CI –1.03 to –0.39), shorter hospitalization time (MD=–0.92, 95% CI –1.66 to –0.19), lower pain scores 1 day after surgery (MD=–0.65, 95% CI –0.90 to –0.40), lower pain scores 3 days after surgery (MD=–0.90, 95% CI –1.16 to –0.64), lower pain scores 7 days after surgery (MD=–1.24, 95% CI –1.90 to –0.57), less number of lymph node dissection (MD=–0.72, 95% CI –1.35 to –0.10), less total drainage fluid (MD=–108.60, 95% CI –180.42 to –36.79) and shorter length of surgical incision (MD=–2.74, 95% CI –3.57 to –1.90) than conventional multiple ports video-assisted thoracic surgery. But the differences between the two groups in operation time, intraoperative blood loss, postoperative complications were not statistically significant. Conclusion Single-incision video-assisted thoracic surgery is safer and better in patient's compliance than conventional multiple ports video-assisted thoracic surgery in the treatment of lung cancer. But there is no significant difference in operation time, intraoperative blood loss, or postoperative complications. It still needs large-scale, high-quality studies to demonstrate its effectiveness and safety.
ObjectiveTo investigate the short-term quality of life in patients after single-direction video-assisted thoracic surgery (VATS) for lung cancer, and explore the related influencing factors. MethodsPatients who underwent single-direction VATS for lung cancer in the Department of Thoracic Surgery, West China Hospital, Sichuan University from July 2020 to August 2021 were continuously selected. The QLQ-C30 and QLQ-LC13 were used to evaluate the quality of life of the patients after the surgery, and the influencing factors were analyzed. ResultsA total of 193 patients were collected. There were 73 males aged 59.44±11.40 years, and 120 females aged 53.73±11.15 years. The QLQ-C30 score of the patients after single-direction VATS for lung cancer was 69.09±20.21 points. Univariate analysis and Pearson correlation analysis showed that age, occupation, anesthesia time, postoperative complications, postoperative antibiotic use time, postoperative hospital stay, insomnia, economic stress, hemoptysis, chest pain, dysphagia, arm or shoulder pain were associated with the quality of life (P≤0.05). The results of multiple regression analysis showed that anesthesia time, economic pressure, insomnia and chest pain had a significant impact on the overall quality of life 30 days after the surgery (P≤0.05). ConclusionThe anesthesia time, economic pressure, insomnia and chest pain are independent influencing factors for the quality of life after the VATS lung cancer surgery.