Uniportal video-assisted thoracoscopic surgery (VATS) for the treatment of early-stage lung cancer with whole pleural adhesion

Background: Uniportal video-assisted thoracoscopic surgery (VATS) is considered a challenging procedure in cases of lung cancer where the entire pleura and lung are attached (whole pleural adhesion). The purpose of this study was to evaluate the surgical results of uniportal VATS for the treatment of lung cancer with whole pleural adhesion. Methods: For all patients who underwent VATS lung cancer surgery at a single hospital in Korea, multiportal VATS was performed before 2017 and uniportal VATS was performed after January 2017 by the same surgeons. The surgical results of multiportal VATS and uniportal VATS for the treatment of lung cancer with whole pleural adhesion were compared retrospectively. Results: There were 16 eligible uniportal VATS cases and 57 multiportal VATS cases. There were no significant differences of clinicopathologic characteristics between the two groups. There were 5 conversions to open thoracotomy in the multiportal VATS group and no conversion to open thoracotomy in the uniportal group (P=0.579). The perioperative and postoperative outcomes were not different between the two groups. There was no mortality in all patients. For patients undergoing VATS lobectomy, the perioperative and postoperative outcomes were similar after uniportal and multiportal VATS lobectomy. For all patients, the 3-year recurrence-free survival (RFS) was 80.0% after uniportal VATS and 79.5% after multiportal VATS (P=0.951) and for patients with stage I NSCLC, the 3-year RFS after uniportal VATS was 91.7% and the 3-year RFS after multiportal VATS was 89.3% (P=0.999). Uniportal VATS was not a significant risk factor for recurrence in the multivariate analysis. Conclusions: Uniportal VATS was not inferior to multiportal VATS in surgical outcome or sho rtterm prognosis in resection of lung cancer with whole pleural adhesion. Whole pleural adhesion is not a contraindication to uniportal VATS, which has been safe and feasible in cases of lung cancer with whole pleural adhesion.