Uniportal video-assisted thoracoscopy major lung resections after neoadjuvant chemotherapy

Uniportal video-assisted thoracoscopic surgery does not increase recurrence rates following pneumonectomy in non-small cell lung cancer: a retrospective study from the National Cancer Center of China

Background

The safety, feasibility, and potential benefits of uniportal video-assisted thoracoscopic surgery (U-VATS) pneumonectomy remain to be investigated. This study aimed to evaluate the postoperative outcomes, survival prognosis, and recurrence patterns in patients undergoing U-VATS versus those undergoing open pneumonectomy. The feasibility of U-VATS pneumonectomy in patients receiving neoadjuvant systemic therapy was also assessed.

Methods

Patients with non-small cell lung cancer (NSCLC) underwent thoracic surgeries at the Cancer Hospital, Chinese Academy of Medical Sciences (CHCAMS) from January 2017 to December 2022. Among these patients, those who underwent U-VATS or open pneumonectomy were included in our study. Propensity score matching (PSM) with a 3:1 ratio was conducted to balance the baseline characteristics between the groups. We compared perioperative outcomes and recurrence patterns between the two groups.

Results

A total of 457 patients who underwent pneumonectomy were included in our study, with 348 in the open pneumonectomy group and 109 in the U-VATS group. After PSM, 334 patients (231 in the open group and 103 in the U-VATS group) were available for subsequent analyses. Patients who underwent U-VATS pneumonectomy experienced shorter postoperative hospital stays (P<0.001). No significant differences were observed in the 5-year overall survival (OS) rate (P=0.19) or the 5-year recurrence-free survival (RFS) rate (P=0.37) between the two groups. Additionally, subgroup analysis of patients receiving neoadjuvant systemic therapy indicated those in the U-VATS group did not exhibit significant differences in recurrence patterns between the two groups.

Conclusions

Patients with NSCLC undergoing U-VATS pneumonectomy exhibit postoperative outcomes, survival rates, and recurrence patterns that are not inferior to those of patients undergoing open pneumonectomy.

Uniportal Video-Assisted Thoracoscopic Anatomic Lung Resection after Neoadjuvant Chemotherapy for Lung Cancer: A Case-Matched Analysis

BACKGROUND

The advantages of video-assisted thoracic surgery (VATS) are well-recognized in several studies. However, in the cases of advanced lung cancer after neoadjuvant chemotherapy (nCT), the role of VATS is still questionable, with concerns about safety, technical feasibility, and oncological completeness. The aim of this study was to assess the impact of nCT on patients who had undergone uniportal VATS (U-VATS) anatomic lung resections for lung cancer, by comparing the short-term outcomes of patients after nCT with case-matched counterparts (treated by surgery alone).

METHODS

We performed a retrospective, comparative study enrolling 927 patients (nCT: 60; non-nCT:867) who underwent U-VATS anatomic lung resections from 2014 to 2020 in two centers. Data were collected in a shared database with standardized variables' definition. Propensity score matching using 15 baseline preoperative patients' characteristics was performed in order to minimize selection-confounding factors between the two groups, which then were directly compared in terms of perioperative outcomes.

RESULTS

After propensity score matching, two groups of 60 patients had been defined. The nCT-group had a higher conversion rate compared to the control group (13.3% vs. 0%, p = 0.003) without an increase in operation time or cardiopulmonary complications. In addition, no differences between the two groups were recorded in terms of prolonged air leaks, length of stay, and readmission.

CONCLUSIONS

U-VATS after nCT is a feasible approach, showing a similar rate of cardiopulmonary complications and length of stay when compared with the control group. However, it remains a challenging surgery due to its great technical complexity as well as the clinical status of the patients.

Uniportal video-assisted thoracoscopic left pneumonectomy: Retrospective analysis of eighteen consecutive patients from a single center

Background

Uniportal video‐assisted thoracoscopic surgery (VATS) is being more widely used in lung cancer, yet reports on its application in pneumonectomies are limited. This study aimed to evaluate the safety and feasibility of uniportal video‐assisted thoracoscopic left pneumonectomy for lung cancer.

Methods

A series of 18 lung cancer patients who had received uniportal video‐assisted thoracoscopic left pneumonectomies were included in the study. Their clinical, pathological, and surgical features, as well as postoperative recovery, were analyzed.

Results

The majority of the patients were male and smokers and their average age was 62.0 ± 8.9 years. All had primary lung cancer, while three (16.7%) had received neoadjuvant therapy. A total of 16 (88.9%) patients had stage II–III disease, with an average tumor size of 3.6 ± 1.5 cm. The average surgery time was 137.4 ± 47.0 minutes, with a 16.7% (3/18) conversion rate. The mean blood loss was 37.5 ± 59.4 mL and no patients needed blood transfusion during, or after, surgery. There was no perioperative death and the overall complication rate was 22.2% (4/18). Two (11.1%) patients needed to stay in the intensive care unit after surgery, and the average length of hospital stay after surgery was 6.3 ± 1.1 days (range 4–7 days).

Conclusions

Uniportal video‐assisted thoracoscopic left pneumonectomy is a safe and feasible procedure for selected lung cancer patients. The use of uniportal VATS in right pneumonectomies and the effect of uniportal video‐assisted thoracoscopic pneumonectomy on the survival of patients merits further study.

Patients receiving uniportal VATS pneumonectomies had standard surgical results and recovery. Uniportal VATS pneumonectomy is safe for properly selected lung cancer patients.

Key points

Significant findings of the study: • Patients receiving uniportal VATS left pneumonectomies had standard surgical results and recovery.

What this study adds: • Uniportal VATS left pneumonectomy is safe for properly selected lung cancer patients.

Uniportal video-assisted thoracic surgery for the treatment of lung cancer: a consensus report from Chinese Society for Thoracic and Cardiovascular Surgery (CSTCVS) and Chinese Association of Thoracic Surgeons (CATS)

Uniportal video-assisted thoracoscopic surgery (UniVATS) has been widely adopted in China, where several ultra-high volume thoracic surgical and training centers are located. The objective of this consensus from Chinese experts was to summarize the current application and give reference for the future development of UniVATS in the treatment of lung cancer. A panel of 41 experts from 21 Chinese hospitals was invited to join this project. The Delphi method was used in this consensus consisting of two rounds of voting. The questionnaire was based on the current clinical evidence. Forty (97.6%) experts completed the 2 rounds of questionnaires. The experts’ experience was relatively similar. We defined the UniVATS as monitor-dependent surgery, no use of rib-spreading and single incision less than 4 cm. Tumor with stage of T1–T3 and N0–N2 is considered amenable to UniVATS. Other consensus was reached on several points outlining the safety and feasibility, surgical skills, learning curve, short-term and long-term outcomes for lung cancer, and current application of subxiphoid and nonintubated UniVATS approach. This consensus statement represents a collective agreement among Chinese experts to suggest that UniVATS is an effective alternative to multi-portal approach, although high-level evidence is expected in the future. Some agreements can be referred in the training of young surgeons.