Outcomes of Uniportal Video-Assisted Thoracoscopic Surgery in the Management of Lobectomy and Segmentectomy for Lung Cancer: A Systematic Review and Meta-Analysis of Propensity Score-Matched Cohorts.

Abstract

Purpose: Uniportal video-assisted thoracoscopic surgery (UVATS) has been increasingly adopted for lung cancer management. This study aims to compare the perioperative and oncological outcomes of UVATS versus multiportal VATS (MVATS).

Methods: A comprehensive search was conducted on electronic databases. Perioperative outcomes evaluated were postoperative complications, conversion to open thoracotomy, and visual analog scale (VAS) scores on postoperative days 1 (POD1) and 3 (POD3). The oncological outcomes assessed were total lymph nodes retrieved. Individual patient time-to-event data were estimated from published Kaplan-Meier curves.

Results: The analysis demonstrated that UVATS was associated with significantly lower postoperative complications (relative risk [RR]: 0.76; 95% confidence interval [CI]: 1.64-0.91; p = 0.002), lower VAS scores on POD1(MD: -0.44; 95% CI: -0.70, -0.17; p = 0.001) and POD3 (MD: 0.76; 95% CI: -1.17, -0.36; p <0.001) compared to MVATS. Although UVATS had a lower conversion rate, this difference was not statistically significant (RR: 0.63; 95% CI: 0.33-1.18; p = 0.15). MVATS retrieved a higher number of lymph nodes, but this difference was also not statistically significant (MD: 0.6; 95% CI: -1.39, 0.12, p = 0.1). The overall survival probability at 96 months was slightly higher in the MVATS group (82.49%) compared to the UVATS group (75.89%), with a p-value of 0.5. Disease-free survival was comparable between the groups (75.43% UVATS and 74.74% MVATS, p = 0.59).

Conclusion: UVATS demonstrated favorable perioperative outcomes and comparable oncological efficacy to MVATS in the management of lobectomy and segmentectomy for lung cancer.