Comparison of the efficacy of subxiphoid and intercostal uniportal video-assisted thoracoscopic surgery in patients with early-stage non-small cell lung cancer.

Abstract

Objective: To compare the efficacy of subxiphoid and intercostal uniportal video-assisted thoracoscopic surgery (VATS) in patients with early-stage non-small cell lung cancer (NSCLC).

Methods: We performed a retrospective chart review of patients with early-stage NSCLC who underwent subxiphoid uniportal video-assisted thoracic surgery (SA-VATS) or intercostal uniportal VATS (IA-VATS) at Shidong Hospital in Shanghai from November 2020 to May 2023. Perioperative conditions including surgical duration, intraoperative blood loss, postoperative catheterization duration, time to first off-bed activities, and number of lymph node dissected were compared between the groups. Degree of pain, preoperative and postoperative lung function, prognosis, and incidence of complications were also compared between the groups.

Results: Records of a total of 128 patients were included. Of them, 72 patients underwent SA-VATS and 56 patients underwent IA-VATS. The duration of SA-VATS was longer, while the intraoperative blood loss and catheterization times were lower compared to those of IA-VATS (P<0.05). Visual analogue scale (VAS) score of patients after SA-VATS was significantly lower than after IA-VATS (P<0.05). There was no significant difference in forced expiratory volume in one second (FEV1) between the two groups before the surgery, and one- and 12 months after the surgery (P>0.05). The prognosis and the incidence of complications were comparable in the two groups after the surgery (P>0.05).

Conclusions: Compared with IA-VATS, SA-VATS is associated with lower intraoperative blood loss, shorter postoperative catheterization and time to first off-bed activities, and less postoperative pain in surgical treatment for early-stage NSCLC. However, there was no significant difference in prognosis and complications between the two approaches.