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Uniportal versus multiportal video-assisted thoracoscopic segmentectomy for non-small cell lung cancer: a systematic review and meta-analysis

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Abstract

It remains controversial whether one-port video-assisted thoracoscopic surgery (VATS) or multiportal VATS is better for segmentectomy in patients with early non-small cell lung cancer (NSCLC). We conducted this meta-analysis of eight published studies to compare the clinical effectiveness and safety of the two surgical approaches. The uniportal group had a shorter postoperative hospital stay (mean difference (MD): − 0.40, 95% CI [− 0.71 to − 0.08] days, p = 0.01), lower postoperative pain scores on day 3 (MD: − 0.90, 95% CI [− 1.26 to − 0.54], p < 0.00001) and day 7 (MD: − 0.33, 95% CI [− 0.62 to − 0.04], p = 0.02), fewer days of chest tube drainage (MD: − 0.47, 95% CI [− 0.78 to − 0.15] days, p = 0.004), and a smaller wound (MD: − 0.73, 95% CI [− 1.00 to − 0.46] cm, p < 0.00001) than the multiportal group. However, there were no significant differences between the groups in complications, operative times, resected lymph nodes, resected lymph node stations, blood loss, postoperative pain scores on days 1, 2, 30, overall survival (OS), or disease-free survival (DFS). The most common complications were prolonged air leakage (10.29%), bleeding (8.82%), vascular injury (7.14%), empyema (5.88%), and arrhythmia (5.26%) in the uniportal group. Overall, uniportal VATS appears to be better than multiportal VATS for segmentectomy in patients with NSCLC, with better postoperative outcomes and similar survival rates.

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Availability of data and material

The data sets used and/or analyzed in this study are available from the corresponding author on reasonable request.

Abbreviations

Ade:

Adenocarcinoma

CI:

Confidence interval

CT:

Cohort study

DFS:

Disease-free survival

DFSR:

Disease-free survival rate

GGO:

Ground glass opacity

GRADE:

Grading of recommendations assessment, development and evaluation

HR:

Hazard ratio

MD:

Mean difference

NOS:

Newcastle–Ottawa scale

NSCLC:

Non-small cell lung cancer

OP:

Operation

OS:

Overall survival

OSR:

Overall survival rate

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

RCT:

Randomized clinical trial

RR:

Risk ratio

SCC:

Squamous cell carcinoma

TNM:

Tumor node metastasis

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Acknowledgements

We thank Professor Jichun Liu, (Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University) for his statistical advice. This study was supported by the National Natural Science Foundation of China (NSFC), number of grants (81560345). Role of the Funding: The funding had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or in the decision to submit the manuscript for publication.

Funding

This study was supported by the National Natural Science Foundation of China (NSFC), number of grants (81560345). Role of the Funding: the funding had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Rd, Nanchang, 330006, China

    Zhongtian Xiang, Bo Wu, Xiang Zhang, Yiping Wei, Jianjun Xu & Wenxiong Zhang

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  1. Zhongtian Xiang
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  2. Bo Wu
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Contributions

ZX and WZ had full access to all of the data in the manuscript and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: All authors. Acquisition, analysis, or interpretation of data: all authors. Drafting of the manuscript: ZX, JX and WZ. Critical revision of the manuscript for important intellectual content: ZX, BW, XZ, YW and WZ. Statistical analysis: ZX, BW, XZ and YW. Supervision: ZX and WZ.

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Correspondence to Wenxiong Zhang.

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Xiang, Z., Wu, B., Zhang, X. et al. Uniportal versus multiportal video-assisted thoracoscopic segmentectomy for non-small cell lung cancer: a systematic review and meta-analysis. Surg Today 53, 293–305 (2023). https://doi.org/10.1007/s00595-021-02442-y

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  • DOI: https://doi.org/10.1007/s00595-021-02442-y

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