Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS: This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I-II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS: Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P < 0.001). There was a statistical difference on the second and third postoperative days; odds ratio (OR) 2.28 [95% confidence interval (CI) 1.62-3.21; P < 0.001] and OR 2.58 (95% CI 1.74-3.83; P < 0.001), respectively. The uniportal-VATS group had higher operative time (P < 0.001), shorter chest drain permanence (P < 0.001) and shorter length of stay (P < 0.001). CONCLUSIONS: Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.

Original languageEnglish
Pages (from-to)714-721
Number of pages8
JournalInteractive Cardiovascular and Thoracic Surgery
Volume29
Issue number5
DOIs
Publication statusPublished - Nov 1 2019

Fingerprint

Video-Assisted Thoracic Surgery
Databases
Pain
Propensity Score
Operative Time
Length of Stay
Thorax
Odds Ratio
Thoracic Diseases
Confidence Intervals
Intraoperative Complications
Postoperative Pain
Non-Small Cell Lung Carcinoma
Multicenter Studies
Comorbidity
Cohort Studies
Lymph Nodes
Neoplasms

Keywords

  • Italian VATS Group
  • Lobectomy
  • Postoperative pain
  • Three-portal
  • Uniportal
  • Video-assisted thoracic surgery

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{fe934d08a30047d3ba9c0e8d29ae6a97,
title = "Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database",
abstract = "OBJECTIVES: This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS: This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I-II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS: Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P < 0.001). There was a statistical difference on the second and third postoperative days; odds ratio (OR) 2.28 [95{\%} confidence interval (CI) 1.62-3.21; P < 0.001] and OR 2.58 (95{\%} CI 1.74-3.83; P < 0.001), respectively. The uniportal-VATS group had higher operative time (P < 0.001), shorter chest drain permanence (P < 0.001) and shorter length of stay (P < 0.001). CONCLUSIONS: Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.",
keywords = "Italian VATS Group, Lobectomy, Postoperative pain, Three-portal, Uniportal, Video-assisted thoracic surgery",
author = "{Italian VATS Group} and Davide Tosi and Mario Nosotti and Gianluca Bonitta and Alessandra Mazzucco and Ilaria Righi and Paolo Mendogni and Lorenzo Rosso and Alessandro Palleschi and Gaetano Rocco and Roberto Crisci",
year = "2019",
month = "11",
day = "1",
doi = "10.1093/icvts/ivz153",
language = "English",
volume = "29",
pages = "714--721",
journal = "Interactive Cardiovascular and Thoracic Surgery",
issn = "1569-9293",
publisher = "European Association for Cardio-Thoracic Surgery",
number = "5",

}

TY - JOUR

T1 - Uniportal and three-portal video-assisted thoracic surgery lobectomy

T2 - analysis of the Italian video-assisted thoracic surgery group database

AU - Italian VATS Group

AU - Tosi, Davide

AU - Nosotti, Mario

AU - Bonitta, Gianluca

AU - Mazzucco, Alessandra

AU - Righi, Ilaria

AU - Mendogni, Paolo

AU - Rosso, Lorenzo

AU - Palleschi, Alessandro

AU - Rocco, Gaetano

AU - Crisci, Roberto

PY - 2019/11/1

Y1 - 2019/11/1

N2 - OBJECTIVES: This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS: This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I-II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS: Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P < 0.001). There was a statistical difference on the second and third postoperative days; odds ratio (OR) 2.28 [95% confidence interval (CI) 1.62-3.21; P < 0.001] and OR 2.58 (95% CI 1.74-3.83; P < 0.001), respectively. The uniportal-VATS group had higher operative time (P < 0.001), shorter chest drain permanence (P < 0.001) and shorter length of stay (P < 0.001). CONCLUSIONS: Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.

AB - OBJECTIVES: This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS: This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I-II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS: Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P < 0.001). There was a statistical difference on the second and third postoperative days; odds ratio (OR) 2.28 [95% confidence interval (CI) 1.62-3.21; P < 0.001] and OR 2.58 (95% CI 1.74-3.83; P < 0.001), respectively. The uniportal-VATS group had higher operative time (P < 0.001), shorter chest drain permanence (P < 0.001) and shorter length of stay (P < 0.001). CONCLUSIONS: Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.

KW - Italian VATS Group

KW - Lobectomy

KW - Postoperative pain

KW - Three-portal

KW - Uniportal

KW - Video-assisted thoracic surgery

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U2 - 10.1093/icvts/ivz153

DO - 10.1093/icvts/ivz153

M3 - Article

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VL - 29

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JO - Interactive Cardiovascular and Thoracic Surgery

JF - Interactive Cardiovascular and Thoracic Surgery

SN - 1569-9293

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