Clinical Outcomes Of Single Utility Port Complete Video-assisted Thoracoscopic Lobectomy For Patients With Early Stage Lung Cancer

Objective:Thoracoscopic lobectomy for the treatment of lung cancer in the world has been widely recognized and applied,there is no uniform fixed surgery.The aim of this study was to investigate the clinical outcomes of single utility port complete video-assisted thoracoscopic lobectomy for patients with early-stage non-small cell lung cancer(NSCLC).Methods:Clinical data from 42 patients with early-stage NSCLC who underwent single utility port complete VATS lobectomy in No.2 People's Hospital of Fuyang City between June 2011 and December 2015 were retrospectively analyzed and compared to data from 86 patients who underwent lobectomy via the traditional multiple-port thoracotomy procedure within the same time range.The time of operation,the amount of blood loss,the number of lymph nodes removed,the rate of thoracic duct drainage,the postoperative drainage time and postoperative hospital stay were compared between the two groups and followed by telephone or outpatient review.Results:Patients' clinical characteristics were similar in both groups.There was no perioperative death in either group.Intraoperative blood loss in single utility port was less than data in multiple-port[(173.69±120.76)ml vs.(220.41±118.42)ml],the difference showed statistical significance(P=0.039).There was no significant difference in operative time[(176.52±23.46)min vs.(169.58±21.53)min,P=0.099],postoperative drainage quantity on the second day[(265.71±156.47)ml vs.(288.84±137.41)ml,P=0.395 ],thoracic drainage duration [(3.93±2.08)d vs.(4.53±2.03)d,P=0.118],hospital-stay-time[(7.69±2.14)d vs.(8.19±2.41)d,P=0.260],number of dissected lymph nodes[(11.86±4.03)vs.(12.79±3.73),P=0.198]and number of stations of lymph node dissected[(5.10±1.68)vs.(5.59±1.42),P=0.082]between single utility port and multiple-port group.There was no difference in terms of post-operative complications(P=0.887).The complication rate for single utility port and multiple-port procedure was 11.9%(5/42)and 12.8%(11/86),respectively.Visual analogue scale(VAS)pain scores(postoperative 1?3?5d)of patients in single utility port were significantly(P<0.05)lower than that of the multiple-port group.A total of 117 patients were followed up(38 cases were followed up in single utility port group and 79 cases in the multiple-port group).Among them,4 cases were missed in single utility port group and 7 cases in the multiple-port group.The overall follow-up rate was 91.4%.The mean follow-up time was 28.5(8-50)months in the single utility port group and 27.23(6-54)months in the multiple-port group.There were 9 patients and 21 patients who died in the single utility port group and the multiple-port group during the follow-up period.There was no significant difference in the survival time between the two groups of non-small cell lung cancer patients(P = 0.659)by log-rank test.Conclusion:Use of single utility port VATS lobectomy for the treatment of early non-small cell lung cancer is technically safe and feasible,less invasive with reduced bleeding and postoperative complications,and enhanced pain relief.Short-term survival time is not inferior to multiple-port VATS.Optimization according to these findings may achieve minimally invasive thoracope utilization.The single utility port VATS lobectomy is worth to promote in the clinical.