Uniportal Video-Assisted Thorascoscopic Surgery - The New Paradigm in the Surgical Treatment of Lung Cancer.

INTRODUCTION: The progressive development and improvement of minimally invasive approaches in the field of thoracic surgery allowed to establish video-assisted thoracoscopic (VATS) anatomic lung resections as the present technique of choice in the treatment of early stage lung cancer.

METHODS: The purpose of this study was to evaluate the surgical outcomes of patients who performed uniportal VATS anatomic lung resections for the treatment of primary lung cancer. The patients' demographics, approach and type of surgery, postoperative morbidity and mortality and overall survival were analyzed.

RESULTS: From December 2013 through September 2017, 173 patients underwent uniportal VATS anatomic lung resections for the treatment of lung cancer. Surgery was performed in 92 male and 81 female with a mean age of 63.5 years (range 19- 83 years). All surgeries began by a single- -port VATS approach, being necessary to add an extra port in 9 surgeries and conversion to mini-thoracotomy in 10 procedures (conversion rate of 5.8%) due to bleeding and/ or technical difficulties. All kinds of anatomic lung resection were performed: 154 lobectomies, which represents 89.0% of the procedures (93 upper lobectomies, 12 middle lobectomies and 49 lower lobectomies), 10 bilobectomies (5.8%) and 9 anatomic segmentectomies (5.2%). Mean lymph node stations dissected was 2.48 stations (range 1-8 stations). The mean surgical time was 112.2 minutes (range 40-245 minutes) and mean intra-operative drainage was 155.6ml (range 0-1400ml). Median hospitalization time was 5 days (range 2-28 days). There was no operative or 30-days mortality and the main complication observed was persistent air leakage in 38 patients (22.0%). Non-small-cell lung cancer (NSCLC) was the main histologic type of cancer (n=149; 86.1%), followed by carcinoid tumours (n=20; 11.6%) and other histologic type (n=4; 2.3%). The mean follow-up time was 15 months (range 0-45 months) and the overall survival was 94.5%.

CONCLUSION: We believe that uniportal VATS anatomic lung resection with systematic lymphadenectomy is technically safe and feasible and it is an alternative approach to thoracotomy or conventional thoracoscopic in the treatment of lung cancer. This approach has demonstrated to be reproducible, comprising all the advantages of a minimal invasive surgery, without jeopardizing the efficiency of the oncologic treatment. Therefore, we suggest that this technique could have a broader implementation and development in all national surgical centers. The issues of patient acceptability, cosmetic and oncologic results, and cost-effectiveness remain to be determined in the future throughout multi-institution randomized controlled trials and long-term follow-up.