TY - JOUR
T1 - Uniportal and three-portal video-assisted thoracic surgery lobectomy
T2 - Analysis of the Italian video-assisted thoracic surgery group database
AU - Italian VATS Group
AU - Tosi, Davide
AU - Nosotti, Mario
AU - Bonitta, Gianluca
AU - Mazzucco, Alessandra
AU - Righi, Ilaria
AU - Mendogni, Paolo
AU - Rosso, Lorenzo
AU - Palleschi, Alessandro
AU - Rocco, Gaetano
AU - Crisci, Roberto
AU - Mancuso, M.
AU - Pernazza, F.
AU - Refai, M.
AU - Bortolotti, L.
AU - Rizzardi, G.
AU - Gargiulo, G.
AU - Dolci, G. P.
AU - Perkmann, R.
AU - Zaraca, F.
AU - Benvenuti, M.
AU - Gavezzoli, D.
AU - Cherchi, R.
AU - Ferrari, P.
AU - Mucilli, F.
AU - Camplese, P.
AU - Melloni, G.
AU - Mazza, F.
AU - Cavallesco, G.
AU - Maniscalco, P.
AU - Voltolini, L.
AU - Gonfiotti, A.
AU - Stella, F.
AU - Argnani, D.
AU - Pariscenti, G. L.
AU - Surrente, C.
AU - Lopez, C.
AU - Droghetti, A.
AU - Giovanardi, M.
AU - Breda, C.
AU - Lo Giudice, F.
AU - Alloisio, M.
AU - Bottoni, E.
AU - Spaggiari, L.
AU - Gasparri, R.
AU - Torre, M.
AU - Rinaldo, A.
AU - Nosotti, M.
AU - Negri, G. P.
AU - Bandiera, A.
AU - Stefani, A.
N1 - Publisher Copyright:
© 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - OBJECTIVES: This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS: This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I-II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS: Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P < 0.001). There was a statistical difference on the second and third postoperative days; odds ratio (OR) 2.28 [95% confidence interval (CI) 1.62-3.21; P < 0.001] and OR 2.58 (95% CI 1.74-3.83; P < 0.001), respectively. The uniportal-VATS group had higher operative time (P < 0.001), shorter chest drain permanence (P < 0.001) and shorter length of stay (P < 0.001). CONCLUSIONS: Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.
AB - OBJECTIVES: This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS: This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I-II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS: Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P < 0.001). There was a statistical difference on the second and third postoperative days; odds ratio (OR) 2.28 [95% confidence interval (CI) 1.62-3.21; P < 0.001] and OR 2.58 (95% CI 1.74-3.83; P < 0.001), respectively. The uniportal-VATS group had higher operative time (P < 0.001), shorter chest drain permanence (P < 0.001) and shorter length of stay (P < 0.001). CONCLUSIONS: Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.
KW - Italian VATS Group
KW - Lobectomy
KW - Postoperative pain
KW - Three-portal
KW - Uniportal
KW - Video-assisted thoracic surgery
UR - http://www.scopus.com/inward/record.url?scp=85074118776&partnerID=8YFLogxK
U2 - 10.1093/icvts/ivz153
DO - 10.1093/icvts/ivz153
M3 - Article
C2 - 31363760
AN - SCOPUS:85074118776
SN - 1569-9293
VL - 29
SP - 714
EP - 721
JO - Interactive Cardiovascular and Thoracic Surgery
JF - Interactive Cardiovascular and Thoracic Surgery
IS - 5
ER -
