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Radicality of mediastinal lymphadenectomy in minimally invasive pulmonary resection: a comparative analysis of uniportal and multiportal thoracoscopic approaches

Czech version

Authors: L. Tulinský 1,2;  M. Kepičová 1,2;  P. Ihnát 1,2;  M. Mitták 1,2;  D. Adamica 1,2;  L. Čierna 1,2;  L. Martínek 1,2
Authors‘ workplace: Chirurgická klinika Fakultní nemocnice Ostrava, Česká republika 1;  Katedra chirurgických studií, Lékařská fakulta, Ostravská univerzita, Česká republika 2
Published in: Rozhl. Chir., 2024, roč. 103, č. 2, s. 48-56.
Category: Original articles
doi: https://doi.org/10.33699/PIS.2024.103.2.48–56

Overview

Introduction: Lung cancer is a serious health problem with a high mortality rate. In the context of surgical management, minimally invasive approaches, including uniportal thoracoscopic techniques, offer potential benefits such as faster recovery and increased patient cooperation. The aim of this study was to compare the accessibility of the mediastinal lymph nodes between uniportal and multiportal thoracoscopic approaches and to verify whether the use of the uniportal approach affects the radicality of the lymphadenectomy.

Methods: A comparative study conducted from January 2015 to July 2022 at the University Hospital Ostrava focused on evaluating the radicality of mediastinal lymphadenectomy between subgroups of patients undergoing surgery using the uniportal thoracoscopic approach and the multiportal thoracoscopic approach.

Results: A total of 278 patients were included in the study. There were no significant differences in the number of available lymphatic stations between the subgroups. The mean number of lymph node stations removed was 6.46 in the left hemithorax and 6.50 in the right hemithorax. Thirty-day postoperative morbidity for the entire patient population was 24.5%, with 18.3% having minor complications and 3.6% having major complications. The overall mortality rate in the study population was 2.5%, with a statistically significant difference in mortality between uniportal and multiportal approaches (1.0% vs 6.4%, p=0.020).

Conclusions: The uniportal approach demonstrated comparable accessibility and lymph node yield to the multiportal approach. There was also no difference in postoperative morbidity between the two approaches. The study suggests the possibility of lower mortality after uniportal lung resection compared with multiportal lung resection, but this conclusion should be interpreted with caution.

Keywords:

Lobectomy – lymphadenectomy – lung recection – uniportal approaches

Sources
  1. Global cancer observatory. Global cancer observatory [online]. Iarc.fr. 2020. Available from: https://gco.iarc.fr/.
  2. Lim E, Batchelor TJP, Dunning J, et al. Video-assisted thoracoscopic or open lobectomy in early-stage lung cancer. NEJM Evid. 2022;1(3). doi:10.1056/EVIDoa2100016.
  3. Nelson DR, Mehran RJ, Mitchell KG, et al. Enhanced recovery after thoracic surgery is associated with improved adjuvant chemotherapy completion for non-small cell lung cancer. J Thorac Cardiovasc Surg. 2019;158(1):279–286. doi:10.1016/j. jtcvs.2019.03.009.
  4. Gonzalez D, Paradela M, Garcia J, et al. Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg. 2011;12(3):514–515. doi:10.1510/ icvts.2010.256222.
  5. Gonzalez-Rivas D, la Torre M, Fernandez R, et al. Single-port video-assisted thoracoscopic left upper lobectomy. Interact Cardiovasc Thorac Surg. 2011;13(5):539–541. doi:10.1510/icvts.2011.274746.
  6. Xie D, Wu J, Hu X, et al. Uniportal versus multiportal video-assisted thoracoscopic surgery does not compromise the outcome of segmentectomy. Eur J Cardiothorac Surg. 2020;59(3):650–657. doi: 10.1093/ejcts/ezaa372.
  7. Xie D, Zhong Y, Deng J, et al. Comparison of uniportal video-assisted thoracoscopic versus thoracotomy bronchial sleeve lobectomy with pulmonary arterioplasty for centrally located non-small-cell lung cancer. Eur J Cardiothorac Surg. 2020;59(5):978–986.  doi:10.1093/ejcts/ezaa404.
  8. Wang L, Liu D, Lu J, et al. The feasibility and advantage of uniportal video-assisted thoracoscopic surgery (VATS) in pulmonary lobectomy. BMC Cancer 2017;17(1). doi:10.1186/s12885-017-3069-z.
  9. Wu L, Wang H, Cai H, et al. Comparison of double sleeve lobectomy by uniportal video-assisted thoracic surgery (VATS) and thoracotomy for NSCLC treatment. Cancer Manag Res. 2019;11:10167–10174. doi:10.2147/CMAR.S226459.
  10. Seely AJE, Ivanovic J, Threader J, et al. Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg. 2010;90(3):936–942. doi:10.1016/j.athoracsur.2010.05.014.
  11. Zhong D, Lin Q, Zhang J, et al. Shortand medium-term outcomes after uniportal and multiportal video-assisted thoracic surgery lobectomy in elderly patients with non-small cell lung cancer. J BU ON. 2021;26(4):1453–1459. doi:10.21203/rs.3.rs-60174/v1.
  12. Chung JH, Choi YS, Cho JH, et al. Uniportal video-assisted thoracoscopic lobectomy: an alternative to conventional thoracoscopic lobectomy in lung cancer surgery? Interact Cardiovasc Thorac Surg. 2015;20(6):813–819. doi:10.1093/icvts/ivv034.
  13. Magouliotis DE, Fergadi MP, Spiliopoulos K, et al. Uniportal versus multiportal video-assisted thoracoscopic lobectomy for lung cancer: an updated meta-analysis. Lung 2021;199(1):43–53. doi:10.1007/ s00408-020-00411-9.
  14. Bourdages-Pageau E, Vieira A, et al. Outcomes of uniportal vs multiportal video-assisted thoracoscopic lobectomy. Semin Thorac Cardiovasc Surg. 2020;32(1): 145–151. doi:10.1053/j.semtcvs.2019.05. 021.
  15. Liu C-C, Shih C-S, Pennarun N, et al. Transition from a multiport technique to a single-port technique for lung cancer surgery: is lymph node dissection inferior using the single-port technique? Eur J Cardiothorac Surg. 2015;49:64–72. doi:10.1093/ejcts/ezv321.
  16. Nachira D, Congedo MT, Tabacco D, et al. Surgical effectiveness of uniportal-VATS lobectomy compared to open surgery in early-stage lung cancer. Front Surg. 2022;9:840070. doi:10.3389/ fsurg.2022.840070.
  17. Zhao J, Zeng Q, Li J, et al. Uniportal versus multiportal thoracoscopic sleeve lobectomy for the surgical treatment of centrally located lung cancer: a single institution experience. J Thorac Dis. 2020;12(12):7145–7155. doi:10.21037/ jtd-20-2695.
  18. Fiorelli A, Forte S, Santini M, et al. Did conversion to thoracotomy during thoracoscopic lobectomy increase post‐operative complications and prejudice survival? Results of best evidence topic analysis. Thorac Cancer 2022;13(15):2085– 2099. doi:10.1111/1759-7714.14525.
  19. Mu J-W, Gao S-G, Xue Q, et al. A matched comparison study of uniportal versus triportal thoracoscopic lobectomy and sublobectomy for early-stage nonsmall cell lung cancer. Chin Med J. 2015;128(20):2731– 2735. doi:10.4103/0366-6999.167298.
  20. Perna V, Carvajal AF, Torrecilla JA, et al. Uniportal video-assisted thoracoscopic lobectomy versus other video-assisted thoracoscopic lobectomy techniques: a randomized study. Eur J Cardiothorac Surg. 2016;50(3):411–415. doi:10.1093/ejcts/ezw161.
  21. Sihoe AD. The evolution of minimally invasive thoracic surgery: implications for the practice of uniportal thoracoscopic surgery. J Thorac Dis. 2014;6(Suppl 6):S604–S617.  doi:10.3978/j.issn.2072-1439.2014.08.52.
  1. Tam JKC, Lim KS. Total muscle-sparing uniportal video-assisted thoracoscopic surgery lobectomy. Ann Thorac Surg. 2013;96(6):1982–1986. doi:10.1016/j.athoracsur. 2013.07.002.
  2. Dai W, Dai Z, Wei X, et al. Early patient-reported outcomes after uniportal vs multiportal thoracoscopic lobectomy. Ann Thorac Surg. 2022;114(4):1229– 1237. doi:10.1016/j.athoracsur. 2021.08.058.
  3. Ng CSH, MacDonald JK, Gilbert S, et al. Optimal approach to lobectomy for non-small cell lung cancer: systemic review and meta-analysis. Innovations  2019;14(2):90–116.  doi:10.1177/1556984519837027.
  4. Kolařík J, Stolz A, Vachtenheim J, et al. Videoasistované a roboticky asistované torakoskopické plicní lobektomie, naše zkušenosti. Rozhl Chir. 2021;100(12):576–583. doi:10.33699/PIS.2021.100.12.576–583.
  5. Kolařík J, Tavandžis J, Novysedlák R, et al. Robotické plicní segmentektomie, iniciální zkušenosti v České republice. Rozhl Chir. 2023;102(5):199–203. doi:10.33699/ PIS.2023.102.5.199–203.
  6. Naruke T, Suemasu K, Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg.1978;76(6):832–839. doi:10.1016/S0022-5223(19)39559-5.
  7. Tulinský L, Kepičová M, Ihnát P, et al. Radicality and safety of mediastinal lymphadenectomy in lung resection: a comparative analysis of uniportal thoracoscopic, multiportal thoracoscopic, and thoracotomy approaches. Surg Endosc. 2023; 37(12):9208–9216. doi:10.1007/s00464-023-10476-1.
  8. Tulinský L, Kepičová M, Mitták M, et al. Metastatický potenciál nemalobuněčného karcinomu plic kategorie T1a a T1b: analýza v české populaci. Rozhl Chir. 2023;102(6):244–250. doi:10.33699/ PIS.2023.102.6.244–250.

MUDr. Lubomír Tulinský, Ph.D.
Chirurgická klinika FN Ostrava
17. listopadu 1790
e-mail: lubomir.tulinsky@fno.cz
ORCID ID: 0000-0003-3100-5990

Labels
Surgery Orthopaedics Trauma surgery
Progress in thoracic surgery (not) only in the Czech Republic
Our experience with robotic-assisted thymic surgery
The role of thoracic surgery in the management of complicated acute and post-acute COVID-19 pneumonia (PASC)
Spontaneous pneumomediastinum – Hamman´s syndrome
For postgradual education
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Perspectives in Surgery

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