Uniportal versus multiportal video-assisted thoracoscopic segmentectomy for non-small cell lung cancer: a systematic review and meta-analysis

It remains controversial whether one-port video-assisted thoracoscopic surgery (VATS) or multiportal VATS is better for segmentectomy in patients with early non-small cell lung cancer (NSCLC). We conducted this meta-analysis of eight published studies to compare the clinical effectiveness and safety of the two surgical approaches. The uniportal group had a shorter postoperative hospital stay (mean difference (MD): - 0.40, 95% CI [- 0.71 to - 0.08] days, p = 0.01), lower postoperative pain scores on day 3 (MD: - 0.90, 95% CI [- 1.26 to - 0.54], p < 0.00001) and day 7 (MD: - 0.33, 95% CI [- 0.62 to - 0.04], p = 0.02), fewer days of chest tube drainage (MD: - 0.47, 95% CI [- 0.78 to - 0.15] days, p = 0.004), and a smaller wound (MD: - 0.73, 95% CI [- 1.00 to - 0.46] cm, p < 0.00001) than the multiportal group. However, there were no significant differences between the groups in complications, operative times, resected lymph nodes, resected lymph node stations, blood loss, postoperative pain scores on days 1, 2, 30, overall survival (OS), or disease-free survival (DFS). The most common complications were prolonged air leakage (10.29%), bleeding (8.82%), vascular injury (7.14%), empyema (5.88%), and arrhythmia (5.26%) in the uniportal group. Overall, uniportal VATS appears to be better than multiportal VATS for segmentectomy in patients with NSCLC, with better postoperative outcomes and similar survival rates.