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Objectives <p>The utilization of uniportal video-assisted thoracoscopic surgery (VATS) has become prevalent, notwithstanding, there are few studies exploring its application specifically in esophagectomy.</p> Methods <p>A retrospective analysis was conducted on data collected from patients diagnosed with clinical stage T1–3/N0/M0 thoracic esophageal cancer, who underwent surgery between January 2017 and December 2020. To evaluate the outcomes, an analysis was conducted utilizing the inverse probability of treatment weighting (IPTW) method.</p> Results <p>This study identified 55 patients who underwent uniportal VATS and 212 patients who underwent multiportal VATS. Postoperative complications classified as Clavien–Dindo grades 1–2 occurred less frequently after uniportal than multiportal VATS in both unadjusted and IPTW-adjusted analyses (10.1% versus 28.8%, respectively; <i>P</i> = 0.018). Upon IPTW analysis, it indicated that the rate of pneumonia (grades 1–2) in the uniportal VATS group was 7.3%, notably lower than the corresponding rate of 23.2% observed in the multiportal VATS group (<i>P</i> = 0.037). Patients in uniportal VATS group had a shorter postoperative length of stay comparing with those in multiportal VATS group (9 versus 10&#xa0;days, <i>P</i> = 0.006 after IPTW). The visual analog scale (VAS) was administered within 7&#xa0;days following surgery and scores were significantly lower in uniportal VATS group (<i>P</i> &lt; 0.001). No surgery-related mortality was observed in uniportal VATS group. The survival benefit observed between two groups was comparable before (<i>P</i> = 0.320) and after IPTW analysis (<i>P</i> = 0.824), indicating no significant difference.</p> Conclusions <p>The utilization of uniportal VATS for esophagectomy demonstrated a reduced occurrence of postoperative complications, accompanied by mitigated postoperative pain, thereby presenting as a viable and practical approach for treating esophageal cancer patients.</p>

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The comparison of uniportal versus multiportal video-assisted thoracic surgery for esophageal cancer: a propensity-weighted analysis

  • 期刊论文

  • 发表日期：

    2025年1月13日

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  • Xin Xiao,
  • Si-Yuan Luan,
  • Shu-Hao Zhang,
  • Qi-Xin Shang,
  • Yu-Shang Yang,
  • Yue Wen,
  • Pin-Hao Fang,
  • Jian-Feng Zhou,
  • Xiao-Kun Li,
  • Yang Hu,
  • Long-Qi Chen,
  • Yong Yuan

摘要

Objectives

The utilization of uniportal video-assisted thoracoscopic surgery (VATS) has become prevalent, notwithstanding, there are few studies exploring its application specifically in esophagectomy.

Methods

A retrospective analysis was conducted on data collected from patients diagnosed with clinical stage T1–3/N0/M0 thoracic esophageal cancer, who underwent surgery between January 2017 and December 2020. To evaluate the outcomes, an analysis was conducted utilizing the inverse probability of treatment weighting (IPTW) method.

Results

This study identified 55 patients who underwent uniportal VATS and 212 patients who underwent multiportal VATS. Postoperative complications classified as Clavien–Dindo grades 1–2 occurred less frequently after uniportal than multiportal VATS in both unadjusted and IPTW-adjusted analyses (10.1% versus 28.8%, respectively; P = 0.018). Upon IPTW analysis, it indicated that the rate of pneumonia (grades 1–2) in the uniportal VATS group was 7.3%, notably lower than the corresponding rate of 23.2% observed in the multiportal VATS group (P = 0.037). Patients in uniportal VATS group had a shorter postoperative length of stay comparing with those in multiportal VATS group (9 versus 10 days, P = 0.006 after IPTW). The visual analog scale (VAS) was administered within 7 days following surgery and scores were significantly lower in uniportal VATS group (P < 0.001). No surgery-related mortality was observed in uniportal VATS group. The survival benefit observed between two groups was comparable before (P = 0.320) and after IPTW analysis (P = 0.824), indicating no significant difference.

Conclusions

The utilization of uniportal VATS for esophagectomy demonstrated a reduced occurrence of postoperative complications, accompanied by mitigated postoperative pain, thereby presenting as a viable and practical approach for treating esophageal cancer patients.