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.

purposeUniportal 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).

methodsA 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.

resultsThe 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).

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