Does single-port video-assisted thoracic lobectomy have favorable perioperative results for non-small cell lung cancer compared with multi-port approach? A systematic review and meta-analysis

Background: The preliminary clinical outcomes and short-term results of single-port video-assisted thoracic surgery (VATS) are encouraging. This study was aimed to assess whether single-port VATS lobectomy have favorable perioperative results for non-small cell lung cancer (NSCLC) compared with multi-port approach. Methods: An electronic search of five databases was performed to find out relevant comparative studies. Outcome measures included operative time, perioperative blood loss, conversion rate, the number of lymph nodes dissection, postoperative pain, chest drainage duration, length of hospital stay, overall postoperative morbidity and mortality. Relative risk (RR) and standard mean difference (SMD) with their 95% confidence intervals (CI) were calculated by means of Stata version 12.0. Results: Eight retrospective observational studies met the inclusion criteria, with a total of 1,257 patients (482 in single-port group and 775 in multi-port group). Meta-analysis showed that single-port VATS lobectomy was associated with less blood loss (SMD=-0.24, 95% CI: -0.48 to 0, P=0.047) and lower overall postoperative morbidity (RR=0.64, 95% CI: 0.45 to 0.92, P=0.015), but higher conversion rate (RR=2.02, 95% CI: 1.10 to 3.73, P=0.024) when compared to multi-port approach. However, when propensity-matched data were analyzed, single-port approach was only associated with less blood loss (SMD=-0.48, 95% CI: -0.69 to -0.25, P<0.001) and postoperative pain (SMD=-0.59, 95% CI: 0.23 to 0.95, P=0.001) when compared to multi-port approach. Conclusions: Single-port VATS lobectomy is a safe and feasible procedure for patients with NSCLC in selected cases. But based on the present findings, there is still insufficient evidence to prove its superior short-term effects than multi-port approach.