title: Transition from a multiport technique to a single-port technique for lung cancer surgery: is lymph node dissection inferior using the single-port technique?†.
abstract: OBJECTIVE
  The feasibility and radicalism of lymph node dissection for lung cancer surgery by a single-port technique has frequently been challenged. We performed a retrospective cohort study to investigate this issue.
  
  
  METHODS
  Two chest surgeons initiated multiple-port thoracoscopic surgery in a 180-bed cancer centre in 2005 and shifted to a single-port technique gradually after 2010. Data, including demographic and clinical information, from 389 patients receiving multiport thoracoscopic lobectomy or segmentectomy and 149 consecutive patients undergoing either single-port lobectomy or segmentectomy for primary non-small-cell lung cancer were retrieved and entered for statistical analysis by multivariable linear regression models and Box-Cox transformed multivariable analysis.
  
  
  RESULTS
  The mean number of total dissected lymph nodes in the lobectomy group was 28.5 ± 11.7 for the single-port group versus 25.2 ± 11.3 for the multiport group; the mean number of total dissected lymph nodes in the segmentectomy group was 19.5 ± 10.8 for the single-port group versus 17.9 ± 10.3 for the multiport group. In linear multivariable and after Box-Cox transformed multivariable analyses, the single-port approach was still associated with a higher total number of dissected lymph nodes.
  
  
  CONCLUSIONS
  The total number of dissected lymph nodes for primary lung cancer surgery by single-port video-assisted thoracoscopic surgery (VATS) was higher than by multiport VATS in univariable, multivariable linear regression and Box-Cox transformed multivariable analyses. This study confirmed that highly effective lymph node dissection could be achieved through single-port VATS in our setting.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Chia-Chuan
authors.initials: CC
authors.lastname: Liu
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Chih-Shiun
authors.initials: CS
authors.lastname: Shih
authors.affiliation: Department of Medical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pennarun
authors.affiliation: Department of Medical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan National Defense University, Taipei, Taiwan chihtao@kfsyscc.org.
authors.forename: Chih-Tao
authors.initials: CT
authors.lastname: Cheng
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D005260:Female; D006801:Humans; D059032:Learning Curve; D016014:Linear Models; D008175:Lung Neoplasms / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: Lobectomy; Lymph node dissection; Segmentectomy; Single port; Video-assisted thoracoscopic surgery