BACKGROUND: Lung cancer poses a significant challenge with high mortality rates. Minimally invasive surgical approaches, including the uniportal thoracoscopic technique, offer potential benefits in terms of recovery and patient compliance. This study focuses on evaluating the radicality of mediastinal lymphadenectomy during uniportal thoracoscopic lung resection, specifically assessing the reachability of established lymphatic stations. METHODS: A comparative study was conducted at the University Hospital Ostrava from January 2015 to July 2022, focusing on the evaluation of radicality in mediastinal lymphadenectomy across three patient subgroups: uniportal thoracoscopic approach, multiportal thoracoscopic approach, and thoracotomy approach. The study implemented the routine identification and excision of 8 lymph node stations from the respective hemithorax to assess the radicality of lymph node harvesting. RESULTS: A total of 428 patients were enrolled and evaluated. No significant differences were observed in the number of lymph nodes removed between the subgroups. The mean number of lymph nodes removed was 6.50 in the left hemithorax and 6.49 in the right hemithorax. The 30-day postoperative morbidity rate for the entire patient population was 27.3%, with 17.5% experiencing minor complications and 6.5% experiencing major complications. Statistically significant differences were observed in major complications between the uniportal approach and the thoracotomy approach (3.5% vs 12.0%, p = 0.002). The overall mortality rate in the study population was 3%, with a statistically significant difference in mortality between the uniportal and multiportal approaches (1.0% vs 6.4%, p = 0.020). CONCLUSIONS: The uniportal approach demonstrated comparable accessibility and lymph node yield to multiportal and thoracotomy techniques. It is equivalent to established methods in terms of postoperative complications, with fewer major complications compared to thoracotomy. While our study indicates a potential for lower mortality following uniportal lung resection in comparison to multiportal lung resection, and demonstrates comparable outcomes to thoracotomy, it is important to approach these findings cautiously and refrain from drawing definitive conclusions.

Department of Craniofacial Surgery Faculty of Medicine University of Ostrava Syllabova 19 703 00 Ostrava Czech Republic

Department of Epidemiology and Public Health Faculty of Medicine University of Ostrava Syllabova 19 703 00 Ostrava Czech Republic

Department of Forensic Medicine University Hospital Ostrava 17 Listopadu 1790 708 52 Ostrava Czech Republic

Department of Otorhinolaryngology and Head and Neck Surgery University Hospital Ostrava 17 Listopadu 1790 70852 Ostrava Czech Republic

Department of Surgery University Hospital Ostrava 17 Listopadu 1790 708 52 Ostrava Czech Republic

Department of Surgical Studies Faculty of Medicine University of Ostrava Syllabova 19 703 00 Ostrava Czech Republic

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Global Cancer Observatory (2020) Global cancer observatory. https://gco.iarc.fr/

Lim E, Batchelor TJP, Dunning J, Shackcloth M, Anikin V, Naidu B (2022) Video-assisted thoracoscopic or open lobectomy in early-stage lung cancer. NEJM Evid 1(3):EVIDoa2100016 DOI

Nelson DR, Mehran RJ, Mitchell KG, Correa AM, Sepesi B, Antonoff MB, Rice DC (2019) Enhanced recovery after thoracic surgery is associated with improved adjuvant chemotherapy completion for non-small cell lung cancer. J Thorac Cardiovasc Surg 158(1):279–286 PubMed DOI

Gonzalez D, Paradela M, Garcia J, dela Torre M (2011) Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg 12(3):514–515 PubMed DOI

Gonzalez-Rivas D, Mercedes FR, Mosquera V (2011) Single-port video-assisted thoracoscopic left upper lobectomy. Interact Cardiovasc Thorac Surg 13(5):539–541 PubMed DOI

Xie D, Wu J, Hu X, Gonzalez-Rivas D, She Y, Chen Q, Zhu Y, Jiang G, Chen C (2020) Uniportal versus multiportal video-assisted thoracoscopic surgery does not compromise the outcome of segmentectomy. Eur J Cardiothorac Surg 59(3):650–657 DOI

Xie D, Zhong Y, Deng J, She Y, Zhang L, Fan J, Jiang G, Zhu Y, Jiang L, Chen C (2020) Comparison of uniportal video-assisted thoracoscopic versus thoracotomy bronchial sleeve lobectomy with pulmonary arterioplasty for centrally located non-small-cell lung cancer. Eur J Cardiothorac Surg 59(5):978–986 DOI

Wang L, Liu D, Lu J, Zhang S, Yang X (2017) The feasibility and advantage of uniportal video-assisted thoracoscopic surgery (VATS) in pulmonary lobectomy. BMC Cancer 17(1):1–7 DOI

Wu L, Wang H, Cai H, Fan J, Jiang G, He Y, Jiang L (2019) Comparison of double sleeve lobectomy by uniportal video-assisted thoracic surgery (vats) and thoracotomy for nsclc treatment. Cancer Manag Res 11:10167–10174 PubMed DOI PMC

Seely AJE, Ivanovic J, Threader J, Al-Hussaini A, Al-Shehab D, Ramsay T, Gilbert S, Maziak DE, Shamji FM, Sundaresan RS (2010) Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg 90(3):936–942 PubMed DOI

Zhong D, Lin Q, Zhang J, Liu Y, Zhan Z (2021) Short- and medium-term outcomes after uniportal and multiportal video-assisted thoracic surgery lobectomy in elderly patients with non-small cell lung cancer. J Balkan Union Oncol 26(4):1453–1459

Chung JH, Choi YS, Cho JH, Kim HK, Kim J, Zo JI, Shim YM (2015) Uniportal video-assisted thoracoscopic lobectomy: an alternative to conventional thoracoscopic lobectomy in lung cancer surgery? Interact Cardiovasc Thorac Surg 20(6):813–819 PubMed DOI

Magouliotis DE, Fergadi MP, Spiliopoulos K, Athanassiadi K (2021) Uniportal versus multiportal video-assisted thoracoscopic lobectomy for lung cancer: an updated meta-analysis. Lung 199(1):43–53 PubMed DOI PMC

Bourdages-Pageau E, Vieira A, Lacasse Y, Figueroa PU (2020) Outcomes of uniportal vs multiportal video-assisted thoracoscopic lobectomy. Semin Thorac Cardiovasc Surg 32(1):145–151 PubMed DOI

Liu C-C, Shih C-S, Pennarun N, Cheng C-T (2015) Transition from a multiport technique to a single-port technique for lung cancer surgery: is lymph node dissection inferior using the single-port technique? Eur J Cardiothorac Surg 49:64–72

Nachira D, Congedo MT, Tabacco D, Sassorossi C, Calabrese G, Ismail M, Vita ML, Petracca-Ciavarella L, Margaritora S, Meacci E (2022) Surgical effectiveness of uniportal-vats lobectomy compared to open surgery in early-stage lung cancer. Front Surg 9:840070 PubMed DOI PMC

Zhao J, Zeng Q, Li J, Tan F, Xue Q, Mu J, Gao Y, Wang D, Gao S (2020) Uniportal versus multiportal thoracoscopic sleeve lobectomy for the surgical treatment of centrally located lung cancer: a single institution experience. J Thorac Dis 12(12):7145–7155 PubMed DOI PMC

Fiorelli A, Forte S, Santini M, Petersen RH, Fang W (2022) Did conversion to thoracotomy during thoracoscopic lobectomy increase post-operative complications and prejudice survival? Results of best evidence topic analysis. Thoracic Cancer 13(15):2085–2099 PubMed DOI PMC

Mu J-W, Gao S-G, Xue Q, Zhao J, Li N, Yang K, Su K, Yuan ZY, He J (2015) A matched comparison study of uniportal versus triportal thoracoscopic lobectomy and sublobectomy for early-stage nonsmall cell lung cancer. Chin Med J 128(20):2731–2735 PubMed DOI PMC

Perna V, Carvajal AF, Torrecilla JA, Gigirey O (2016) Uniportal video-assisted thoracoscopic lobectomy versus other video-assisted thoracoscopic lobectomy techniques: a randomized study. Eur J Cardiothorac Surg 50(3):411–415 PubMed DOI

Sihoe AD (2014) The evolution of minimally invasive thoracic surgery: implications for the practice of uniportal thoracoscopic surgery. J Thorac Dis 6(Suppl 6):S604–S617 PubMed PMC

Tam JKC, Lim KS (2013) Total muscle-sparing uniportal video-assisted thoracoscopic surgery lobectomy. Ann Thorac Surg 96(6):1982–1986 PubMed DOI

Dai W, Dai Z, Wei X, Pompili C, Shi Q-L, Xie T-P, He JT, Li Q (2022) Early patient-reported outcomes after uniportal vs multiportal thoracoscopic lobectomy. Ann Thorac Surg 114(4):1229–1237 PubMed DOI

Ng CSH, MacDonald JK, Gilbert S, Khan AZ, Kim YT, Louie BE, Blair Marshall M, Santos RS, Scarci M, Shargal Y, Fernando HC (2019) Optimal approach to lobectomy for non-small cell lung cancer: systemic review and meta-analysis. Innovations 14(2):90–116 PubMed

Naruke T, Suemasu K, Ishikawa S (1978) Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg 76(6):832–839 PubMed DOI

Harris CG, James RS, Tian DH, Yan TD, Doyle MP, Gonzalez-Rivas D, Cao C (2016) Systemic review and meta-analysis of uniportal versus multiportal video-assisted thoracoscopy lobectomy for lung cancer. Ann Cardiothorac Surg 5(2):76–84 PubMed DOI PMC