• Etienne Bourdages-Pageau, Arthur Vieira, Yves Lacasse, and Figueroa Paula Ugalde PU Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et Pneumologie de Quebec, Quebec, Canada. Electronic addres.
• Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et Pneumologie de Quebec, Quebec, Canada.
• Semin. Thorac. Cardiovasc. Surg. 2020 Jan 1; 32 (1): 145-151.

AbstractThe optimal number of incisions for video-assisted thoracoscopic surgery (VATS) lobectomy, the standard treatment for early-stage nonsmall cell lung cancer (NSCLC), is still a matter of great debate. To compare single-incision (uniportal) VATS (U-VATS) with traditional multiportal VATS (M-VATS), we retrospectively reviewed the surgical outcomes of a large cohort of patients. Our prospectively maintained institutional database was queried retrospectively. All patients from 2014 to 2017 who underwent VATS lobectomy as the primary procedure for clinical stage I or II NSCLC were identified. A univariate comparison and a propensity-matched analysis incorporating preoperative variables were performed. The incidence of postoperative complications was compared. During the study period, 722 patients underwent VATS lobectomy for early-stage NSCLC, 62% by M-VATS, and 38% by U-VATS. In the univariate analysis, U-VATS performed by an experienced surgeon was associated with decreased intraoperative bleeding and shortened duration of surgery, duration of chest tube drainage, and length of hospital stay as compared with M-VATS (P < 0.001). Mediastinal lymph node dissection and complete resection were accomplished similarly using U-VATS and M-VATS. When the 2 approaches were compared through propensity matching, U-VATS was associated with fewer pneumonias (P = 0.012), as well as decreased intraoperative bleeding (P < 0.001), faster surgery (P < 0.001), shorter duration of chest tube drainage (P = 0.001), and shorter hospital stay (P < 0.001). At our institution, in the hands of an experienced surgeon, U-VATS lobectomy is safe, feasible, and can result in similar short-term outcomes for early-stage NSCLC as compared with M-VATS.Copyright © 2019 Elsevier Inc. All rights reserved.

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