Uniportal Versus Multiportal Thoracoscopic Sleeve Lobectomy for the Surgical Treatment of Centrally Located Lung Cancer: a Single Institution Experience

Background: Uniportal thoracoscopic sleeve lobectomy is rarely reported owing to its high degree of difficulty. We conducted a comparative study on the safety and efficacy of uniportal versus multiportal thoracoscopic sleeve lobectomy for the treatment of centrally located lung cancer. Methods: From January 2016 to December 2018, 30 thoracoscopic sleeve lobectomies (12 by the uniportal approach and 20 by the multiportal approach) for centrally located lung cancer at our institution were retrospectively analyzed. Results: The uniportal approach resulted in a significantly shorter chest drainage duration (5.3 +/- 1.9 vs. 7.1 +/- 2.8 days, P=0.028) and a smaller chest drainage volume (796.7 +/- 582.9 vs. 1,667.8 +/- 1,154.9 mL, P=0.004) than the multiportal approach. The two groups showed no significant differences in the dissection of lymph nodes, operation time, estimated blood loss, conversion rate, length of postoperative hospital stay and the proportion of patients with postoperative complications. The short-term overall survival (OS) and disease-free survival (DFS) between uniportal and multiportal groups were similar (3-year OS, 100.0% vs. 82.5%, P=0.222; 3-year DIES, 75.8% vs. 84.4%, P=0.641). For the eight cases of the uniportal approach conducted by the same surgeon, the cumulative sum (CUSUM) curve showed its inflection at patient number 4 and divided the series into phase I (learning phase) and phase II (experienced phase). A significant reduction in estimated blood loss (42.5 +/- 8.7 vs. 177.5 +/- 121.2 mL, P=0.037), chest drainage volume (280.0 +/- 155.8 vs. 972.5 +/- 464.5 mL, P=0.043) and chest drainage duration (3.8 +/- 1.0 vs. 6.8 +/- 2.2 days, P=0.027) was also noted in the phase II patients compared with the phase I patients. Conclusions: Uniportal thoracoscopic sleeve lobectomy is technically feasible and safe for the treatment of centrally located lung cancer and may achieve superior surgical outcomes compared with the multiportal approach.