Comparative Study of Survival following Videothoracoscopic Lobectomy Procedures for Lung Cancer: Single- versus Multiple-port Approaches.
BACKGROUND
Video-assisted thoracoscopic surgery has become the technique of choice in the early stages of lung cancer in many centers although there is no evidence that all of the surgical approaches achieve the same long-term survival.


METHODS
We carried out a retrospective review of 276 VATS lobectomies performed in our department, analyzing age, sex, comorbidities, current smoker, FEV1 and FCV, surgical approach, TNM and pathological stage, histologic type, neoadjuvant or coadjuvant chemotherapy, relapse and metastasis time, with the main aim of evaluating the survival rate and disease-free time, especially with regard to the two/three versus single port approach.


RESULTS
The one/four year global survival rate was 88.1 and 67.6% respectively. Bivariate analysis found that the variables associated with survival are comorbidity, histological type, stage, surgical approach and need for chemotherapy. When we independently analyzed the surgical approach, we found a lower survival rate in the single-port group vs. the two/three-port group (VATS). Stratifying by tumoral stage (stage I) and by tumor size (T2) survival was significantly lower for patients with single-port group in comparison to VATS approach. In the multivariate analysis, single-port group is associated with a higher risk of death (HR=1.78). In analyzing disease-free survival, differences were found in both cases in favor of two/three port VATS: p=.093 for local relapses and p=.091 for the development of metastasis.


CONCLUSIONS
These results challenge the use of the single port technique in malignant lung pathologies, suggesting the need for clinical trials in order to identify the role this technique may have in lung cancer surgery.
Departamento de Cirugía Torácica, Hospital Universitario de A Coruña, A Coruña, España. Electronic address: jbormat@sergas.es.
José M
JM
Borro
Departamento de Cirugía, Universidad de A Coruña, A Coruña, España.
Francisco
F
Regueiro
Departamento de Epidemiología Clínica y Bioestadística, Hospital Universitario de A Coruña, A Coruña, España.
Sonia
S
Pértega
Departamento de Oncología Médica, Hospital de Pontevedra, Pontevedra, España.
Manuel
M
Constenla
Departamento de Epidemiología Clínica y Bioestadística, Hospital Universitario de A Coruña, A Coruña, España.
Salvador
S
Pita
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted; D013997:Time Factors
Análisis de supervivencia; Cirugía; Cirugía torácica videoasistida; Cáncer de pulmón; Lobectomy; Lobectomía; Lung cancer; Single-port; Surgery; Survival analysis; Uniportal; VATS