Comparison of perioperative results between uniportal and three-portal thoracoscopic lobectomy for non-small cell lung cancer: A systematic review and meta-analysis of randomized controlled trials_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHEN Zhongzhong , ZHOU Ke , LIN Huahang , CAO Jie , LIANG Linchuan , WANG Lei , PENG Zhiyu ,  MEI Jiandong

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

MEI Jiandong, Email: jiandongmei@aliyun.com

Keywords：

Non-small cell lung cancer; video-assisted thoracic surgery; lobectomy; uniportal; multiple-portal; three-portal; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202206063

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To compare the perioperative results between uniportal and three-portal thoracoscopic lobectomy for non-small cell lung cancer (NSCLC). Methods Electronic databases including PubMed, Web of Science, EMbase, CNKI, Wanfang were systematically searched from the establishment of each database until April 2022. Literature screening, data extraction and bias risk assessment were independently conducted by two researchers. All combined results were performed by RevMan 5.3 and Stata 16.0. The quality of the literature and the risk of bias were evaluated using the Cochrane Bias Risk Assessment Tool. Results Eighteen eligible randomized controlled trials (1 597 patients) were identified eventually, including 800 patients undergoing uniportal thoracoscopic lobectomy and 797 patients undergoing three-portal thoracoscopic lobectomy. Meta-analysis results showed that compared to the three-portal approach, uniportal lobectomy took longer operation time (WMD=7.63, 95%CI 2.36 to 12.91, P=0.005) with less intraoperative blood loss (WMD=–28.81, 95%CI –42.54 to –15.08, P<0.001). Furthermore, patients undergoing uniportal lobectomy achieved lower visual analogue score within 24 hours after the operation (WMD=–1.60, 95%CI –2.26 to –0.94, P<0.001), less volume of drainage after the operation (WMD=–25.30, 95%CI –46.22 to –4.37, P=0.020), as well as shorter drainage duration (WMD=–0.36, 95%CI –0.72 to –0.01, P=0.040). Besides, patients undergoing uniportal lobectomy were also observed with shorter length of hospital stay (WMD=–2.28, 95%CI –2.68 to –1.88, P<0.001) and lower incidence of postoperative complications (RR=0.49, 95%CI 0.38 to 0.63, P<0.001). However, the number of lymph nodes harvested during the operation (WMD=–0.01, 95%CI –0.24 to 0.21, P=0.930) was similar between the two groups. Conclusion Both uniportal and three-portal thoracoscopic lobectomy for NSCLC are safe and feasible. The uniportal approach is superior in reducing short-term postoperative pain, postoperative complications and shortening the length of hospital stay.

Citation： SHEN Zhongzhong, ZHOU Ke, LIN Huahang, CAO Jie, LIANG Linchuan, WANG Lei, PENG Zhiyu, MEI Jiandong. Comparison of perioperative results between uniportal and three-portal thoracoscopic lobectomy for non-small cell lung cancer: A systematic review and meta-analysis of randomized controlled trials. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(10): 1367-1375. doi: 10.7507/1007-4848.202206063 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Nguyen KS, Neal JW, Wakelee H. Review of the current targeted therapies for non-small-cell lung cancer. World J Clin Oncol, 2014, 5(4): 576-587.
3.	葛建軍, 趙子恩. 電視胸腔鏡手術治療肺癌的爭議與進展. 現代實用醫學, 2010, 22(7): 837-840.
4.	劉海青, 呂榮增, 楊振華. 單孔胸腔鏡下肺葉切除術對周圍型肺癌患者術中出血量、生存率及并發癥的影響. 青島醫藥衛生, 2019, 51(6): 416-418.
5.	艾孜子·阿不來提, 艾力江·多力坤, 陳康. 單孔法電視胸腔鏡手術治療早期肺癌的遠近期療效觀察. 生物醫學工程與臨床, 2020, 24(4): 415-419.
6.	陳宇, 鄭紅葵, 錢琳, 等. 單孔胸腔鏡與三孔胸腔鏡進行肺葉切除術的對比分析. 中國現代醫生, 2016, 54(35): 40-43.
7.	Tosi D, Nosotti M, Bonitta G, et al. Uniportal and three-portal video-assisted thoracic surgery lobectomy: Analysis of the Italian video-assisted thoracic surgery group database. Interact Cardiovasc Thorac Surg, 2019, 29(5): 714-721.
8.	鄧衛軍, 顧云, 陳桂明, 等. 單孔與三孔胸腔鏡肺癌根治術對患者術后疼痛及短期生活質量的對比研究. 泰山醫學院學報, 2020, 41(4): 297-298.
9.	Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1. 0. The Cochrane Collaboration. 2013.
10.	Yao J, Chang Z, Zhu L, et al. Uniportal versus multiportal thoracoscopic lobectomy: Ergonomic evaluation and perioperative outcomes from a randomized and controlled trial. Medicine (Baltimore), 2020, 99(42): e22719.
11.	朱震. 單孔與三孔胸腔鏡肺葉切除術治療周圍型肺癌的臨床療效比較. 臨床醫藥文獻電子雜志, 2019, 6(A4): 80-81.
12.	周斌, 劉傳彬, 王家富, 等. 單孔胸腔鏡肺葉切除術與三孔胸腔鏡肺葉切除術治療周圍型肺癌效果觀察. 臨床誤診誤治, 2017, 30(8): 94-97.
13.	趙帥. 單操作孔完全胸腔鏡肺葉切除術治療周圍型肺癌患者的療效及安全性分析. 黑龍江醫藥科學, 2020, 43(2): 90-91,93.
14.	張紹宇, 黃東, 何純, 等. 單孔胸腔鏡下肺葉切除術治療非小細胞肺癌患者的臨床效果. 醫療裝備, 2019, 32(13): 98-99.
15.	袁金權, 周建平, 杜巍, 等. 三孔與單孔胸腔鏡肺葉切除術治療肺癌的效果對比. 臨床醫學工程, 2017, 24(12): 1659-1660.
16.	姚文杰, 李宏芹. 單孔胸腔鏡肺葉切除術用于早期非小細胞肺癌治療的效果及安全性分析. 武警后勤學院學報(醫學版), 2020, 29(12): 30-33.
17.	閆穎偉. 周圍型肺癌在兩種胸腔鏡下肺葉切除術的術后效果分析. 齊齊哈爾醫學院學報, 2019, 40(4): 422-423.
18.	許哲源, 汪洋, 彭浩. 單孔與三孔胸腔鏡下肺葉切除術治療非小細胞肺癌的臨床療效對比分析. 中外醫療, 2019, 38(4): 41-43.
19.	許哲源, 彭浩, 汪洋. 單孔與三孔胸腔鏡肺葉切除術治療肺癌的臨床效果對比. 中國當代醫藥, 2018, 25(32): 32-34.
20.	王徽. 單操作孔完全胸腔鏡與傳統三孔胸腔鏡治療肺癌的療效比較. 中國醫藥指南, 2020, 18(15): 37-38.
21.	孫濟生. 單孔和三孔胸腔鏡術在早期肺癌患者治療中效果比較. 中外醫療, 2018, 37(21): 19-21.
22.	侍曄, 劉政呈, 曹琿, 等. 單孔胸腔鏡肺葉切除并縱隔淋巴結清掃治療Ⅰ~Ⅱ期非小細胞肺癌的臨床研究. 中國醫刊, 2020, 55(12): 1315-1319.
23.	林潔桓, 馬駿, 陳福楠, 等. 單孔胸腔鏡下肺葉切除術治療肺癌的臨床治療體會. 當代醫學, 2020, 26(9): 154-155.
24.	李朝平. 單孔胸腔鏡下肺葉切除術治療早期非小細胞肺癌的臨床效果觀察. 世界最新醫學信息文摘, 2019, 19(38): 28-29.
25.	靳鋒, 趙衛兵, 付天澤. 單孔胸腔鏡肺葉切除術對肺癌患者淋巴結清掃數目及并發癥的影響. 中國校醫, 2021, 35(3): 205-207.
26.	馮志健, 盧帥, 張其瑞. 探討單操作孔全胸腔鏡肺葉切除術的臨床治療效果. 系統醫學, 2020, 5(19): 78-80.
27.	Ye Z, Zhang B, Chen Y, et al. Comparison of single utility port video-assisted thoracoscopic surgery (VATS) and three-port VATS for non-small cell lung cancer. Oncol Lett, 2019, 18(2): 1311-1317.
28.	趙曉龍, 孟勝藍, 蔡云婷, 等. 胸腔鏡下肺葉切除術和肺段切除術治療肺癌患者臨床療效及其對肺功能影響的比較. 疑難病雜志, 2016, 15(7): 690-693.
29.	Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
30.	Gonzalez D, Paradela M, Garcia J, et al. Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg, 2011, 12(3): 514-515.
31.	Bertolaccini L, Batirel H, Brunelli A, et al. Uniportal video-assisted thoracic surgery lobectomy: A consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 56(2): 224-229.
32.	Li T, Xia L, Wang J, et al. Uniportal versus three-port video-assisted thoracoscopic surgery for non-small cell lung cancer: A retrospective study. Thorac Cancer, 2021, 12(8): 1147-1153.
33.	肖懷清. 單孔與三孔胸腔鏡對肺結節/腫塊手術的臨床療效對比. 浙江大學, 2016.
34.	李彩偉, 徐美青, 徐廣文, 等. 單孔與三孔胸腔鏡肺部手術后急慢性疼痛的對比研究. 中國肺癌雜志, 2018, 21(4): 279-284.
35.	Tamura M, Shimizu Y, Hashizume Y. Pain following thoracoscopic surgery: Retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery. J Cardiothorac Surg, 2013, 8: 153.
36.	郝志鵬, 蔡奕欣, 付圣靈, 等. 單孔與三孔胸腔鏡肺癌根治術對患者術后疼痛及短期生活質量的對比研究. 中國肺癌雜志, 2016, 19(3): 122-128.
37.	于海明. 單孔法與三孔法胸腔鏡手術治療91例周圍型肺癌的臨床對比研究. 現代診斷與治療, 2019, 30(3): 463-465.
38.	丁理星, 夏俊. 三孔胸腔鏡肺葉切除術與單孔胸腔鏡肺葉切除術治療非小細胞肺癌患者的療效比較. 實用中西醫結合臨床, 2020, 20(6): 127-128.
39.	喻傲, 焦子宸, 王濤. 早期拔除胸腔引流管在胸腔鏡肺部手術后的應用. 中華腔鏡外科雜志(電子版), 2020, 13(6): 347-351.
40.	陳乙婕, 費毅, 陳獻珊, 等. 肺癌根治術后并發癥危險因素分析及其生活質量變化研究. 現代生物醫學進展, 2021, 21(17): 3315-3319, 3345.
41.	馬駿, 張智光, 胡蕓海. 胸腔鏡肺葉切除術后引流量與術后肺部并發癥的相關性分析. 中國胸心血管外科臨床雜志, 2019, 26(6): 569-573.
42.	Brunelli A, Varela G, Refai M, et al. A scoring system to predict the risk of prolonged air leak after lobectomy. Ann Thorac Surg, 2010, 90(1): 204-209.
43.	李華勝, 梅建東, 趙珂嘉. 肺手術后持續性漏氣的現狀及相關進展. 中國胸心血管外科臨床雜志, 2016, 23(8): 832-836.
44.	黃韌. 普外科手術切口感染危險因素分析及預防措施. 臨床醫藥文獻電子雜志, 2019, 6(94): 73, 86.
45.	王希文, 趙俊剛. 單孔胸腔鏡肺癌根治術與傳統三孔手術的對比分析. 重慶醫學, 2016, 45(28): 3959-3961, 3964.
46.	楊懿, 劉倫旭. 單孔胸腔鏡與傳統多孔胸腔鏡手術治療肺癌有效性及安全性的系統評價與Meta分析. 中國胸心血管外科臨床雜志, 2018, 25(3): 222-232.
47.	程棟梁, 林稱意, 曾敏, 等. 三孔與單孔胸腔鏡手術治療早期肺癌的近期療效比較. 現代腫瘤醫學, 2017, 25(24): 4007-4009.
48.	Chang JM, Kam KH, Yen YT, et al. From biportal to uniportal video-assisted thoracoscopic anatomical lung resection: A single-institute experience. Medicine (Baltimore), 2016, 95(40): e5097.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Nguyen KS, Neal JW, Wakelee H. Review of the current targeted therapies for non-small-cell lung cancer. World J Clin Oncol, 2014, 5(4): 576-587.
3. 葛建軍, 趙子恩. 電視胸腔鏡手術治療肺癌的爭議與進展. 現代實用醫學, 2010, 22(7): 837-840.
4. 劉海青, 呂榮增, 楊振華. 單孔胸腔鏡下肺葉切除術對周圍型肺癌患者術中出血量、生存率及并發癥的影響. 青島醫藥衛生, 2019, 51(6): 416-418.
5. 艾孜子·阿不來提, 艾力江·多力坤, 陳康. 單孔法電視胸腔鏡手術治療早期肺癌的遠近期療效觀察. 生物醫學工程與臨床, 2020, 24(4): 415-419.
6. 陳宇, 鄭紅葵, 錢琳, 等. 單孔胸腔鏡與三孔胸腔鏡進行肺葉切除術的對比分析. 中國現代醫生, 2016, 54(35): 40-43.
7. Tosi D, Nosotti M, Bonitta G, et al. Uniportal and three-portal video-assisted thoracic surgery lobectomy: Analysis of the Italian video-assisted thoracic surgery group database. Interact Cardiovasc Thorac Surg, 2019, 29(5): 714-721.
8. 鄧衛軍, 顧云, 陳桂明, 等. 單孔與三孔胸腔鏡肺癌根治術對患者術后疼痛及短期生活質量的對比研究. 泰山醫學院學報, 2020, 41(4): 297-298.
9. Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1. 0. The Cochrane Collaboration. 2013.
10. Yao J, Chang Z, Zhu L, et al. Uniportal versus multiportal thoracoscopic lobectomy: Ergonomic evaluation and perioperative outcomes from a randomized and controlled trial. Medicine (Baltimore), 2020, 99(42): e22719.
11. 朱震. 單孔與三孔胸腔鏡肺葉切除術治療周圍型肺癌的臨床療效比較. 臨床醫藥文獻電子雜志, 2019, 6(A4): 80-81.
12. 周斌, 劉傳彬, 王家富, 等. 單孔胸腔鏡肺葉切除術與三孔胸腔鏡肺葉切除術治療周圍型肺癌效果觀察. 臨床誤診誤治, 2017, 30(8): 94-97.
13. 趙帥. 單操作孔完全胸腔鏡肺葉切除術治療周圍型肺癌患者的療效及安全性分析. 黑龍江醫藥科學, 2020, 43(2): 90-91,93.
14. 張紹宇, 黃東, 何純, 等. 單孔胸腔鏡下肺葉切除術治療非小細胞肺癌患者的臨床效果. 醫療裝備, 2019, 32(13): 98-99.
15. 袁金權, 周建平, 杜巍, 等. 三孔與單孔胸腔鏡肺葉切除術治療肺癌的效果對比. 臨床醫學工程, 2017, 24(12): 1659-1660.
16. 姚文杰, 李宏芹. 單孔胸腔鏡肺葉切除術用于早期非小細胞肺癌治療的效果及安全性分析. 武警后勤學院學報(醫學版), 2020, 29(12): 30-33.
17. 閆穎偉. 周圍型肺癌在兩種胸腔鏡下肺葉切除術的術后效果分析. 齊齊哈爾醫學院學報, 2019, 40(4): 422-423.
18. 許哲源, 汪洋, 彭浩. 單孔與三孔胸腔鏡下肺葉切除術治療非小細胞肺癌的臨床療效對比分析. 中外醫療, 2019, 38(4): 41-43.
19. 許哲源, 彭浩, 汪洋. 單孔與三孔胸腔鏡肺葉切除術治療肺癌的臨床效果對比. 中國當代醫藥, 2018, 25(32): 32-34.
20. 王徽. 單操作孔完全胸腔鏡與傳統三孔胸腔鏡治療肺癌的療效比較. 中國醫藥指南, 2020, 18(15): 37-38.
21. 孫濟生. 單孔和三孔胸腔鏡術在早期肺癌患者治療中效果比較. 中外醫療, 2018, 37(21): 19-21.
22. 侍曄, 劉政呈, 曹琿, 等. 單孔胸腔鏡肺葉切除并縱隔淋巴結清掃治療Ⅰ~Ⅱ期非小細胞肺癌的臨床研究. 中國醫刊, 2020, 55(12): 1315-1319.
23. 林潔桓, 馬駿, 陳福楠, 等. 單孔胸腔鏡下肺葉切除術治療肺癌的臨床治療體會. 當代醫學, 2020, 26(9): 154-155.
24. 李朝平. 單孔胸腔鏡下肺葉切除術治療早期非小細胞肺癌的臨床效果觀察. 世界最新醫學信息文摘, 2019, 19(38): 28-29.
25. 靳鋒, 趙衛兵, 付天澤. 單孔胸腔鏡肺葉切除術對肺癌患者淋巴結清掃數目及并發癥的影響. 中國校醫, 2021, 35(3): 205-207.
26. 馮志健, 盧帥, 張其瑞. 探討單操作孔全胸腔鏡肺葉切除術的臨床治療效果. 系統醫學, 2020, 5(19): 78-80.
27. Ye Z, Zhang B, Chen Y, et al. Comparison of single utility port video-assisted thoracoscopic surgery (VATS) and three-port VATS for non-small cell lung cancer. Oncol Lett, 2019, 18(2): 1311-1317.
28. 趙曉龍, 孟勝藍, 蔡云婷, 等. 胸腔鏡下肺葉切除術和肺段切除術治療肺癌患者臨床療效及其對肺功能影響的比較. 疑難病雜志, 2016, 15(7): 690-693.
29. Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
30. Gonzalez D, Paradela M, Garcia J, et al. Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg, 2011, 12(3): 514-515.
31. Bertolaccini L, Batirel H, Brunelli A, et al. Uniportal video-assisted thoracic surgery lobectomy: A consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 56(2): 224-229.
32. Li T, Xia L, Wang J, et al. Uniportal versus three-port video-assisted thoracoscopic surgery for non-small cell lung cancer: A retrospective study. Thorac Cancer, 2021, 12(8): 1147-1153.
33. 肖懷清. 單孔與三孔胸腔鏡對肺結節/腫塊手術的臨床療效對比. 浙江大學, 2016.
34. 李彩偉, 徐美青, 徐廣文, 等. 單孔與三孔胸腔鏡肺部手術后急慢性疼痛的對比研究. 中國肺癌雜志, 2018, 21(4): 279-284.
35. Tamura M, Shimizu Y, Hashizume Y. Pain following thoracoscopic surgery: Retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery. J Cardiothorac Surg, 2013, 8: 153.
36. 郝志鵬, 蔡奕欣, 付圣靈, 等. 單孔與三孔胸腔鏡肺癌根治術對患者術后疼痛及短期生活質量的對比研究. 中國肺癌雜志, 2016, 19(3): 122-128.
37. 于海明. 單孔法與三孔法胸腔鏡手術治療91例周圍型肺癌的臨床對比研究. 現代診斷與治療, 2019, 30(3): 463-465.
38. 丁理星, 夏俊. 三孔胸腔鏡肺葉切除術與單孔胸腔鏡肺葉切除術治療非小細胞肺癌患者的療效比較. 實用中西醫結合臨床, 2020, 20(6): 127-128.
39. 喻傲, 焦子宸, 王濤. 早期拔除胸腔引流管在胸腔鏡肺部手術后的應用. 中華腔鏡外科雜志(電子版), 2020, 13(6): 347-351.
40. 陳乙婕, 費毅, 陳獻珊, 等. 肺癌根治術后并發癥危險因素分析及其生活質量變化研究. 現代生物醫學進展, 2021, 21(17): 3315-3319, 3345.
41. 馬駿, 張智光, 胡蕓海. 胸腔鏡肺葉切除術后引流量與術后肺部并發癥的相關性分析. 中國胸心血管外科臨床雜志, 2019, 26(6): 569-573.
42. Brunelli A, Varela G, Refai M, et al. A scoring system to predict the risk of prolonged air leak after lobectomy. Ann Thorac Surg, 2010, 90(1): 204-209.
43. 李華勝, 梅建東, 趙珂嘉. 肺手術后持續性漏氣的現狀及相關進展. 中國胸心血管外科臨床雜志, 2016, 23(8): 832-836.
44. 黃韌. 普外科手術切口感染危險因素分析及預防措施. 臨床醫藥文獻電子雜志, 2019, 6(94): 73, 86.
45. 王希文, 趙俊剛. 單孔胸腔鏡肺癌根治術與傳統三孔手術的對比分析. 重慶醫學, 2016, 45(28): 3959-3961, 3964.
46. 楊懿, 劉倫旭. 單孔胸腔鏡與傳統多孔胸腔鏡手術治療肺癌有效性及安全性的系統評價與Meta分析. 中國胸心血管外科臨床雜志, 2018, 25(3): 222-232.
47. 程棟梁, 林稱意, 曾敏, 等. 三孔與單孔胸腔鏡手術治療早期肺癌的近期療效比較. 現代腫瘤醫學, 2017, 25(24): 4007-4009.
48. Chang JM, Kam KH, Yen YT, et al. From biportal to uniportal video-assisted thoracoscopic anatomical lung resection: A single-institute experience. Medicine (Baltimore), 2016, 95(40): e5097.

Previous Article
胰腺外實性假乳頭狀瘤1例報道
Next Article
Advances in diagnosis and treatment of polycystic liver disease

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison of perioperative results between uniportal and three-portal thoracoscopic lobectomy for non-small cell lung cancer: A systematic review and meta-analysis of randomized controlled trials

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content