Thoracoscopic Lobectomy of Single-port versus Multi-port Video-assisted Thoracoscopic Surgery for Peripheral Non-small Cell Lung Cancer: A Case Control Study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YINXun-liang ^1,2 , ZHOUYong-an ¹ , ZHAONing ² , WANGDong ² , SHENYi ² ,  WEIYu-cheng ²

1. Department of Thoracic Surgery of the Tangdu Hospital of the Fourth Military Medical University, Xian 710038, P. R. China;
2. Department of Thoracic Surgery of the Affiliated Hospital of Qingdao University, Qingdao 266003 Shandong, P. R. China;

Corresponding author：

WEIYu-cheng, Email: weiyuchengchest@163.com

Keywords：

Single-port; Multi-port; Video-assisted thoracoscopic surgery; Peripheral non-small cell lung cancer

DOI：

10.7507/1007-4848.20160246

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Objective To compare and analyze clinical effects of video-assisted thoracoscopic surgery (VATS) lobectomy and systematic lymph node harvests for peripheral non-small cell lung cancer (PNSCLC) patients between single-port (SP) and multi-port (MP) with a propensity-matched analysis. Methods We retrospectively analyzed the clinical data of 324 patients presented with PNSCLC and admitted in the Affiliated Hospital of Qingdao University from January 2013 through December 2015. Six-eight patients underwent single-port thoracoscopic lobectomy were as a SP group and 256 patients with multi-port thoracoscopic lobectomy. Another 68 patients were produced by a propensity-matched analysis in these 256 patients, to match with SP group as a MP group. There were 26 males and 42 females at age of 54-62 (59.3±10.3) years in the SP group. There were 32 males and 36 females at age of 50-66 (61.5±9.4) years in the MP group. Perioperative outcomes were compared between the two groups. Results All operations were accomplished successfully, without conversion to thoracotomy. Most postoperative outcomes were similar in intraoperative blood loss (136.3±22.7 ml vs. 142.2±20.3 ml), conversion (4.4% vs. 7.4%), lymph node dissection number (19.9±3.5 vs. 20.0±3.0), station (7.9±2.3 vs. 8.3±2.1), postoperative drainage volume (761.4±182.3 ml vs. 736.9±176.4 ml), chest drainage duration (5.2±1.5 d vs. 5.8±1.8 d), length of hospital stay (5.5±2.0 d vs. 5.0±2.5 d), and postoperative complications (2.9% vs. 7.4%) between the two groups (P > 0.05). There were statistical differences in operation time (138.2±20.3 min vs. 126.4±22.4 min), downtrend of pain scores (P=0.03), and patients' satisfaction level (8.8±1.4 vs. 7.3±2.3, P < 0.05). Concision Single-port thoracoscopic lobectomy is not inferior to multi-port and is a safe and feasible surgical procedure for the management of PNSCLC.

Citation： YINXun-liang, ZHOUYong-an, ZHAONing, WANGDong, SHENYi, WEIYu-cheng. Thoracoscopic Lobectomy of Single-port versus Multi-port Video-assisted Thoracoscopic Surgery for Peripheral Non-small Cell Lung Cancer: A Case Control Study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(11): 1044-1049. doi: 10.7507/1007-4848.20160246 Copy

1.	万人安, 尹逊亮, 魏煜程, 等.非小细胞肺癌术前纵隔淋巴结分期诊断的现状分析.中国胸心血管外科临床杂志, 2015, 22(7): 691-695.
2.	Trivino A, Congregado M, Loscertales J, et al. Experience and develo-pment of the video-assisted thoracic surgery lobectomy technique: comparative study with conventional surgery in stage I non-small cell lung cancer. Arch Bronconeumol, 2014, 50(2): 57-61.
3.	田文鑫, 佟宏峰, 孙耀光, 等.两孔、三孔胸腔镜与开放肺叶切除治疗肺癌的对比研究.中国微创外科杂志, 2014, 11(14): 994-997.
4.	李畅, 马海涛, 何靖康, 等.单操作孔肺叶切除术治疗周围型肺癌的临床研究.中国肺癌杂志, 2013, 9(16): 487-491.
5.	Swanson SJ, Herndon JE, Damico TA, et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802-a prospective, multi-institution feasibility study. J Clin Oncol, 2007, 25(31): 4993-4997.
6.	初向阳, 薛志强, 刘毅, 等.单操作孔电视胸腔镜肺叶切除术治疗早期肺癌的临床研究.中国胸心血管外科临床杂志, 2012, 19(2): 113-115.
7.	陈刚.全胸腔镜下肺癌微创手术-肺癌手术的发展趋势.循证医学, 2013, 13(2): 84-90.
8.	范盛浩, 葛明建, 谢廷洪, 等.电视胸腔镜与传统开胸肺叶切除术治疗原发性非小细胞肺癌.中国胸心血管外科临床杂志, 2009, 16(6): 449-453.
9.	Rocco G, Khalil M, Jutley R. Uniportal video-assisted thoracoscopic surgery wedge lung biopsy in the diagnosis of interstitial lung diseases. J Thorac Cardiovasc Surg, 2005, 129: 947-948.
10.	Gonzalez-Rivas D, Fernandez R, La Torre MD, et al. Single-port video-assisted thoracoscopic left upper lobectomy. Interact Cardio-vasc Thorac Surg, 2011, 13(5): 539-541.
11.	Gonzalez-Rivas D, Mendez L, Delgado M, et al. Single-port video-assisted thoracoscopic anatomic segmentectomy and right upper lobectomy. Eur J Cardiothorac Surg, 2012, 42(6): 169-171.
12.	Zhu Y, Xu GB, Zheng B, et al. Single-port video-assisted thoracos-copic surgery lung resection: experiences in Fujian Medical Univer-sity Union Hospital. J Thorac Dis, 2015, 7: 1241-1251.
13.	车国卫, 刘伦旭.单孔电视胸腔镜手术临床应用的现状与进展.中国胸心血管外科临床杂志, 2012, 19(2): 181-184.
14.	Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg, 2006, 81(3): 1013-1019.
15.	Okada M, Sakamoto T, Yuki T, et al. Selective mediastinal lympha-denectomy for clinico-surgical stage I non-small cell lung cancer. Ann Thorac Surg, 2006, 81(3): 1028-1032.
16.	Lardinois D, Suter H, Hakki H, et al. Morbidity, survival, and site of recurrence after mediastinal lymph-node dissection versus systematic sampling after complete resection for non-small cell lung cancer. Ann Thorac Surg, 2005, 80(1): 268-274.
17.	Shen Y, Wang H, Feng M, et al. Single-versus multiple-port thoraco-scopic lobectomy for lung cancer: a propensity-matched study. Eur J Cardiothorac Surg, 2015, 49(1): 48-53.
18.	Wang BY, Liu CY, Hsu PK, et al. Single-incision versus multiple-incision thoracoscopic lobectomy and segmentectomy: a propensity-matched analysis. Ann Surg, 2015, 261(4): 793-799.
19.	Young R, McElnay P, Leslie R, et al. Is uniport thoracoscopic surgery less painful than multiple port approaches? Interact Cardiovasc Thorac Surg, 2015, 20(3): 409-414.
20.	Tamura M, Shimizu Y, Hashizume Y. Pain following thoracoscopic surgery: retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery. J Cardiothorac Surg, 2013, 8(1): 153.
21.	Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken), 2011, 63: 240-252.
22.	Jensen MP, Karoly P, Oriordan EF, et al. The subjective experience of acute pain: an assessment of the utility of 10 indices. Clin J Pain, 1989, 5(2): 153-159.

1. 万人安, 尹逊亮, 魏煜程, 等.非小细胞肺癌术前纵隔淋巴结分期诊断的现状分析.中国胸心血管外科临床杂志, 2015, 22(7): 691-695.
2. Trivino A, Congregado M, Loscertales J, et al. Experience and develo-pment of the video-assisted thoracic surgery lobectomy technique: comparative study with conventional surgery in stage I non-small cell lung cancer. Arch Bronconeumol, 2014, 50(2): 57-61.
3. 田文鑫, 佟宏峰, 孙耀光, 等.两孔、三孔胸腔镜与开放肺叶切除治疗肺癌的对比研究.中国微创外科杂志, 2014, 11(14): 994-997.
4. 李畅, 马海涛, 何靖康, 等.单操作孔肺叶切除术治疗周围型肺癌的临床研究.中国肺癌杂志, 2013, 9(16): 487-491.
5. Swanson SJ, Herndon JE, Damico TA, et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802-a prospective, multi-institution feasibility study. J Clin Oncol, 2007, 25(31): 4993-4997.
6. 初向阳, 薛志强, 刘毅, 等.单操作孔电视胸腔镜肺叶切除术治疗早期肺癌的临床研究.中国胸心血管外科临床杂志, 2012, 19(2): 113-115.
7. 陈刚.全胸腔镜下肺癌微创手术-肺癌手术的发展趋势.循证医学, 2013, 13(2): 84-90.
8. 范盛浩, 葛明建, 谢廷洪, 等.电视胸腔镜与传统开胸肺叶切除术治疗原发性非小细胞肺癌.中国胸心血管外科临床杂志, 2009, 16(6): 449-453.
9. Rocco G, Khalil M, Jutley R. Uniportal video-assisted thoracoscopic surgery wedge lung biopsy in the diagnosis of interstitial lung diseases. J Thorac Cardiovasc Surg, 2005, 129: 947-948.
10. Gonzalez-Rivas D, Fernandez R, La Torre MD, et al. Single-port video-assisted thoracoscopic left upper lobectomy. Interact Cardio-vasc Thorac Surg, 2011, 13(5): 539-541.
11. Gonzalez-Rivas D, Mendez L, Delgado M, et al. Single-port video-assisted thoracoscopic anatomic segmentectomy and right upper lobectomy. Eur J Cardiothorac Surg, 2012, 42(6): 169-171.
12. Zhu Y, Xu GB, Zheng B, et al. Single-port video-assisted thoracos-copic surgery lung resection: experiences in Fujian Medical Univer-sity Union Hospital. J Thorac Dis, 2015, 7: 1241-1251.
13. 车国卫, 刘伦旭.单孔电视胸腔镜手术临床应用的现状与进展.中国胸心血管外科临床杂志, 2012, 19(2): 181-184.
14. Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg, 2006, 81(3): 1013-1019.
15. Okada M, Sakamoto T, Yuki T, et al. Selective mediastinal lympha-denectomy for clinico-surgical stage I non-small cell lung cancer. Ann Thorac Surg, 2006, 81(3): 1028-1032.
16. Lardinois D, Suter H, Hakki H, et al. Morbidity, survival, and site of recurrence after mediastinal lymph-node dissection versus systematic sampling after complete resection for non-small cell lung cancer. Ann Thorac Surg, 2005, 80(1): 268-274.
17. Shen Y, Wang H, Feng M, et al. Single-versus multiple-port thoraco-scopic lobectomy for lung cancer: a propensity-matched study. Eur J Cardiothorac Surg, 2015, 49(1): 48-53.
18. Wang BY, Liu CY, Hsu PK, et al. Single-incision versus multiple-incision thoracoscopic lobectomy and segmentectomy: a propensity-matched analysis. Ann Surg, 2015, 261(4): 793-799.
19. Young R, McElnay P, Leslie R, et al. Is uniport thoracoscopic surgery less painful than multiple port approaches? Interact Cardiovasc Thorac Surg, 2015, 20(3): 409-414.
20. Tamura M, Shimizu Y, Hashizume Y. Pain following thoracoscopic surgery: retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery. J Cardiothorac Surg, 2013, 8(1): 153.
21. Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken), 2011, 63: 240-252.
22. Jensen MP, Karoly P, Oriordan EF, et al. The subjective experience of acute pain: an assessment of the utility of 10 indices. Clin J Pain, 1989, 5(2): 153-159.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Thoracoscopic Lobectomy of Single-port versus Multi-port Video-assisted Thoracoscopic Surgery for Peripheral Non-small Cell Lung Cancer: A Case Control Study

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