| Objective:To study the safety, feasibility and resection effect of modular radical surgery of lung cancer under uniportal video-assisted thoracoscopic surgery(uniportal-VATS).Methods:Data of 334 patients with lung cancer who treated with uniportal-VATS(uniportal-VATS group, n=225) or three portal VATS(3P-VATS group, n=109) during March 2015 to December 2015 were retrospectively analyzed. All the patients underwent modular lung cancer radical resection(anatomical lobectomy/segmentectomy with systematic lymphadenectomy), the whole operation was divided into five modular??inferior mediastinum lymphadenectomy modular(station 8 and 9);?subcarinal lymphadenectomy modular (station 7);?right superior mediastinum lymphadenectomy modular (station 2R and 4R);?left superior mediastinum lymphadenectomy modular(station 4L to 6) and ?anatomical lobectomy/segmentectomy modular. The operation was completed under different techonoloy roadmap according to different side of tumor(left or right). Patients' clinical, tumor and operation data(including pleural adhesions, opertion time, blood loss, operation method, number of dissected lymph nodes, conversion rate and so on) were assessed. Time of post-operative ICU treatment, number of patients who received fiberbronchoscope suction and suction number per capita were compared between the two groups as well as the post-operative chest tube duration, hospital stay and incidence of complication. Then we analyzed all the indexes above in patients with stage ?, stage II or stage III according to their post-operative TNM staging, respectively.Results:There were 126 male and 99 female in uniportal-VATS group while 3 P-VATS group had 66 male and 43 femal. Both groups were similar in clinical and tumor characteristics(P=0.05), there were no perioperative death in two groups. There were 12 patients converted to add operation hole or thoracotomy in uniportal-VATS group while 4 patients converted to thoracotomy in 3P-VATS group, the convertion rate between the two groups had not statistical difference. While the operative time of uniportal-VATS group(144.9±16.0)min was longer than that of the 3P-VATS group[(135.1±13.9)min, P<0.001], the blood loss and number of resected lymph nodes in uniportal-VATS group[(79.9±27.8)ml, (17.4±3.0)] were both similar with those of 3P-VATS group[(77.7±22.2)ml, (17.6±2.8), P=0.463, P=0.580]. Time of post-operative ICU treatment [(24.2±9.6)h vs (25.4±7.9)h] and fiberbronchoscope suction rate (24.9% vs 27.5%)were similar in two groups(P=0.264, P=0.606), however, the number of fiberbronchoscope suction per capita in uniportal group(1.4±0.6) was much less than that in 3P-VATS(1.6±0.7, P=0.046), no difference was found for the incidence of complication between the two groups(P>0.05). The chest tube duration and post-operative hospital stay of uniportal group[(4.4±1.3)d,(9.4±1.4)d]were both significantly shorter than those of 3P-VATS[(5.0±1.3)d,(10.3±1.6)d](both P?0.001).The uniportal-VATS and 3P-VATS were then compared in different staging patients(stage ?,? and stage ?), the operation time of uniportal-VATS were all much longer than those of 3P-VATS in each staging(stage I:140.2±11.6min vs 131.9±11.1min, P?0.001; stage II: 157.0±17.0min vs 140.0±11.5min,P=0.001; stage III:158.8±21.1min vs 141.6±19.8min, P=0.004), there were no significant difference in blood loss, operation methods, number of resceted lymph nodes and convertion rate between uniportal-VATS and 3P-VATS in all staging as well as time of post-operative ICU treatment, fiberbronchoscope suction rate and post-operative comlication rate, but in stage I patients, the number of fiberbronchoscope suction per capita was much less in uniportal-VATS group(1.3±0.6) than in 3P-VATS(1.6±0.7, P=0.045), no significant difference were found between the groups in stage ? and stage ? patients(P=0.574, p=0.875). The chest tube duration after uniportal-VATS in the three stages were (4.4±1.2)d, (4.6±2.0)d and(4.4±1.3)d, respectively, which were significantly shorter than those of 3P-VATS[(4.7±1.1)d, (5.8±1.6)d and (5.4±1.4)d,0.041, P=0.050, P=0.010]. In stage I and stage ? patients, post-operative hospital stay of uniportal-VATS were both much shorter than those of 3P-VATS group[stage I:(9.2±1.0)d vs (9.3±1.3)d, P=0.002; stage ?:(10.0±1.9)d vs(11.6±1.9)d, P=0.004], while in stage ?, there was no difference between the two groups.[(10.0±2.2)d vs (10.9±1.5)d, P=0.144].Conclusion:Modular radical surgery of lung cancer under uniportal-VATS is feasible during clinical application, the resection effect is similar with 3P-VATS and would not increase the risk of post-operative complication, it can also promote patient's fast recovery after operation.Objective:To investigate the effect of mediastinal lymphadenectomy under modular lung cancer radical resection with uniportal video-assisted thoracoscopic surgery(uniportal-VATS) and assess the application value of this procedure in the surgical treatment of lung cancer.Methods:Data of 311 patients with non-small cell lung cancer(NSCLC) who underwent lung cancer radical resection with uniportal-VATS(uniportal-VATS group, n=208) or three portal VATS(3P-VATS group, n=103) during March 2015 to December 2015 were retrospectively analyzed. All the patients received anatomical lobectomy/segmentectomy with systematic lymphadenectomy. Patients' clinical characteristic, tumor feature and operation data(including opertion time, blood loss, operation method, chest tube duration, post-operative hospital stay and morbidity rate) were assessed. The number of total lymph nodes(LNs) and stations dissected through uniportal-VATS were compared with 3P-VATS as well as the number of N2 LNs and stations. Each N2 station LNs was analyed and compared between the groups. The mediastinal LNs dissected effect of each approach was then compared in patients with stage ?, stage ? or stage ?a, respectively.Results:There were 110 male and 98 female in uniportal-VATS group while 3P-VATS group had 61 male and 42 femal. Patients' clinical and tumor characteristics were similar in both groups(P>0.05). There were no perioperative death in two groups, the operation method was also similar in both groups. While the operative time of uniportal-VATS group(144.8±15.3)min was longer than that of the 3P-VATS group[(135.1±13.9)min, P< 0.001], there were no difference in terms of the blood loss. The overall numbers of stations and LNs in uniportal-VATS group(7.3±1.0,17.5±3.0) were similar with those in 3P-VATS group(7.2±1.0,17.7±2.7, P=0.208,P=0.596). The numbers of N stations(uniportal-VATS:4.3±0.7,3P-VATS:4.3±0.6) and LNs(uniportal-VATS:8.6±1.1, 3P-VATS:8.5±1.1) were also similar in both groups(P=0.850, P=0.587). There were no difference in the dissected rate and number of each N2 station LNs between two groups. When compared in patients with stage ?, stage ? or stage ?a respectively, the numbers of overall dissected stations and LNs were all similar in both groups as well as the numbers of dissected N2 stations and LNs. The chest tube duration and post-operative hospital stay of uniportal-VATS[(4.4±1.3)d and (9.2±0.9)d] were both much shorter than those of 3P-VATS groups[(5.0±1.3)d and (9.8±2.0)d, both P<0.001]. No significant difference was found in morbidity rate between the two groups.Conclusion:Modular radical resction of lung cancer with uniportal-VATS could gain similar LNs dissection effect when compared with 3P-VATS, the mediastinal lymphadenectomy effect is not inferior to 3P-VATS either, it has practical clinical value in surgical therapy of lung cancer.Objective:The aim of this study is to investigate the feasibility, safety and drainage effect of double 16F chest tubes drainage adopting a U model method which was used for the post-operative chest draining after lung cancer radical surgery with uniportal video-assisted thoracic surgery(uniportal-VATS).Methods:A total of 88 patients' data who underwent uniportal-VATS for radical resection of non-small cell lung cancer(NSCLC) were reviewed. Among them, either one 30F chest tube(large bore tube group, LBT group) or two 16F chest tubes(small bore tube group, SBT group) were inserted into chest cavity through the incision at the end of the operation.In SBT group, the two 16F chest tubes were placed as a U model viewing from the lateral. Patients' clinical characteristics, tumor feature and operative data were analyzed as well as the post-operative complications. The overall volume of chest drainage, chest tube duration and post-operative hospital stay were compared between the two groups to evaluate the draining effect of SBT. Visual analogue scale(VAS) was used to assess the minimum and maximum pain score(VASmin and VASmax) on the 3 rd and 7th post-operative day. Incidence of incision numbness were compared between the two groups 3 months after operation.Results:Both groups were similar in clinical characteristics and tumor features, there were no perioperative death in two groups. No statistically significant difference was detected in the operation methds, blood loss and number of dissected lymph nodes(all P>0.05). While the chest tube duration of SBT group(5.2±2.1)d was shorter than that of the LBT group[(6.2±2.4)d, P=0.044], the overall chest drain volume of SBT group were similar with LBT group[(1172.6±348.3)ml vs (1245.7±422.6)ml,P=0.138]. The postoperative hospital stay of LBT group(12.8±2.4)d were longer than that of SBT group[(11.7±2.6)d, P=0.043]. Incision oozing rate was significantly lower in SBT group(2.2%) than in LBT group(16.7%)(P=0.025), no statistically significant difference was reported in any other complications between the two groups. The VASmix-d3,d7 in SBT group were similar with LBT group(both P?0.05), but VASmax-d3,d7 were all significantly less in SBT group(3.77±0.75,2.02±0.39) than in 3P-VATS group(4.14±0.75,2.21±0.41,P=0.022, P=0.046). Compared with LBT group, the incidence of incision numbness was lower(19.6% vs 40.5%, P=0.032) in SBT group at the 3 months follow-up.Conclusion:Chest drainage with two 16F chest tubes adopting a U model placement could be used as a safe and effective method for post-operative chest cavity management after lung cancer radical resection with uniportal-VATS, this drainage method could shorten patient's post-operative chest tube duration and hospital stay, it can also relief post-operative pain and incision numbness which may contribute to quicker recovery.Objective:The aim of this study is to preliminary investigate the effect of uniportal video-assisted thoracic surgery(uniportal-VATS) on post-operative pain and short-term quality of life.Methods Data of 272 patients who underwent uniportal-VATS (n=176) or three portal VATS(3P-VATS)(n=96) for radical resection of non-small cell lung cancer(NSCLC) were analyzed. The clinical and operative data were assessed, visual analogue scale(VAS) was used to evaluate the minimum and maximum pain score(VASmin and VASmax) on the 3rd and 7th post-operative day. Chinese version 4.0 of Functional Assessment of Cancer Treatment-Lung(FACT-L) was applied to evaluate the short-term quality of life preoperatively and 3 months after operation, respectively. Incidence of incision numbness and satisfaction rate of incision appearance were compared between the two groups 3 months after operation.Results Both groups were similar in clinical characteristics, there were no perioperative death in two groups. While the operative time of uniportal-VATS group(144.3±15.50)min was longer than that of the 3P-VATS group[(135.1±14.3)min, P<0.001], the chest tube duration and postoperative hospital stay of uniportal-VATS group[(44.4±1.2)d, (9.5±1.3)d] were both shorter than those of 3P-VATS group[(5.0±1.4)d, (10.2±1.6)d, both?0.001]. No statistically significant difference was reported in VASmin-d3 between the two groups, however, VASmin-d7, VASmax-d3,d7 were all significantly less in uniportal-VATS group(1.41±0.26,3.74±0.54,2.39±0.51) than in 3P-VATS group(1.54±0.28,3.94±0.51, 2.64±0.60,P=0.003,P=0.003,P?0.001).FACT-L assessment indicated that the scores of patients' functional status, emotional status and overall quality of life 3 months after the surgery in uniportal VATS group(21.1±2.1,20.1±1.7,108.6±4.4) were all higher than those in 3P-VATS group(20.2±1.9,19.3±1.7,106.8±4.2,P=0.005,P=0.004, P=0.008), there were no significant differences between the two groups in physical status, social and family conditions as well as in lung cancer subscale. Compared with 3P-VATS group, the incidence of incision numbness was lower(25.6% vs 40.6%,P=0.010) and satisfaction rate of incision was higher(77.8% vs 64.6%, P=0.018) in uniportal- VATS group at the 3 months follow-up. Conclusion Compared with 3P-VATS, uniportal-VATS radical lobectomy could reduce post-operative pain and improve short-term postoperative quality of life, it has practical clinical value in surgical therapy of lung cancer. |
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