title: Is uniportal thoracoscopic surgery a feasible approach for advanced stages of non-small cell lung cancer?
abstract: OBJECTIVE
  Conventional video-assisted thoracoscopic (VATS) lobectomy for advanced lung cancer is a feasible and safe surgery in experienced centers. The aim of this study is to assess the feasibility of uniportal VATS approach in the treatment of advanced non-small cell lung cancer (NSCLC) and compare the perioperative outcomes and survival with those in early-stage tumors operated through the uniportal approach.
  
  
  METHODS
  From June 2010 to December 2012, we performed 163 uniportal VATS major pulmonary resections. Only NSCLC cases were included in this study (130 cases). Patients were divided into two groups: (A) early stage and (B) advanced cases (>5 cm, T3 or T4, or tumors requiring neoadjuvant treatment). A descriptive and retrospective study was performed, comparing perioperative outcomes and survival obtained in both groups. A survival analysis was performed with Kaplan-Meier curves and the log-rank test was used to compare survival between patients with early and advanced stages.
  
  
  RESULTS
  A total of 130 cases were included in the study: 87 (A) vs. 43 (B) patients (conversion rate 1.1 vs. 6.5%, P=0.119). Mean global age was 64.9 years and 73.8% were men. The patient demographic data was similar in both groups. Upper lobectomies (A, 52 vs. B, 21 patients) and anatomic segmentectomies (A, 4 vs. B, 0) were more frequent in group A while pneumonectomy was more frequent in B (A, 1 vs. B, 6 patients). Surgical time was longer (144.9±41.3 vs. 183.2±48.9, P<0.001), and median number of lymph nodes (14 vs. 16, P=0.004) were statistically higher in advanced cases. Median number of nodal stations (5 vs. 5, P=0.165), days of chest tube (2 vs. 2, P=0.098), HOS (3 vs. 3, P=0.072), and rate of complications (17.2% vs. 14%, P=0.075) were similar in both groups. One patient died on the 58th postoperative day. The 30-month survival rate was 90% for the early stage group and 74% for advanced cases.
  
  
  CONCLUSIONS
  Uniportal VATS lobectomy for advanced cases of NSCLC is a safe and reliable procedure that provides perioperative outcomes similar to those obtained in early stage tumours operated through this same technique. Further long term survival analyses are ongoing on a large number of patients.
authors: 1 Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain ; 2 Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.
authors: Diego
authors: D
authors: Gonzalez-Rivas
authors: 1 Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain ; 2 Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.
authors: Eva
authors: E
authors: Fieira
authors: 1 Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain ; 2 Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.
authors: Maria
authors: M
authors: Delgado
authors: 1 Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain ; 2 Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.
authors: Lucía
authors: L
authors: Mendez
authors: 1 Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain ; 2 Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.
authors: Ricardo
authors: R
authors: Fernandez
authors: 1 Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain ; 2 Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.
authors: Mercedes
authors: M
authors: de la Torre
keywords: Advanced lung cancer; minimally invasive surgery; non-small cell lung cancer (NSCLC); thoracoscopy; uniportal; video-assisted thoracoscopic(VATS) lobectomy