Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database

被引：20

作者：

Tosi, Davide ^{[1
]}

Nosotti, Mario ^{[1
]}

Bonitta, Gianluca ^{[1
]}

Mazzucco, Alessandra ^{[1
]}

Righi, Ilaria ^{[1
]}

Mendogni, Paolo ^{[1
]}

Rosso, Lorenzo ^{[1
]}

Palleschi, Alessandro ^{[1
]}

Rocco, Gaetano ^{[2
]}

Crisci, Roberto ^{[3
]}

Mancuso, M. ^{[4
]}

Pernazza, F. ^{[4
]}

Refai, M. ^{[5
]}

Bortolotti, L. ^{[6
]}

Rizzardi, G. ^{[6
]}

Gargiulo, G. ^{[7
]}

Dolci, G. P. ^{[7
]}

Perkmann, R. ^{[8
]}

Zaraca, F. ^{[8
]}

Benvenuti, M. ^{[9
]}

Gavezzoli, D. ^{[9
]}

Cherchi, R. ^{[10
]}

Ferrari, P. ^{[10
]}

Mucilli, F. ^{[11
]}

Camplese, P. ^{[11
]}

Melloni, G. ^{[12
]}

Mazza, F. ^{[12
]}

Cavallesco, G. ^{[13
]}

Maniscalco, P. ^{[13
]}

Voltolini, L. ^{[14
]}

Gonfiotti, A. ^{[14
]}

Stella, F. ^{[15
]}

Argnani, D. ^{[15
]}

Pariscenti, G. L. ^{[16
]}

Lurilli ^{[16
]}

Surrente, C. ^{[17
]}

Lopez, C. ^{[17
]}

Droghetti, A. ^{[18
]}

Giovanardi, M. ^{[18
]}

Breda, C. ^{[19
]}

Lo Giudice, F. ^{[19
]}

Alloisio, M. ^{[20
]}

Bottoni, E. ^{[20
]}

Spaggiari, L. ^{[21
]}

Gasparri, R. ^{[21
]}

Torre, M. ^{[22
]}

Rinaldo, A. ^{[22
]}

Nosotti, M. ^{[23
]}

Rosso, L. ^{[23
]}

Negri, G. P. ^{[24
]}

机构：

[1] Fdn Irccs Ca Granda Osped Maggiore Policlin, Thorac Surg & Lung Transplant Unit, Via Francesco Sforza 35, I-20122 Milan, Italy

[2] Mem Sloan Kettering Canc Ctr, Dept Surg, Thorac Serv, 1275 York Ave, New York, NY 10021 USA

[3] Univ Aquila, G Mazzini Hosp, Thorac Surg Unit, Teramo, Italy

[4] Alessandria Hosp, Alessandria, Italy

[5] Ancona Hosp, Salesi, Italy

[6] Humanitas Gavazzeni, Bergamo, Italy

[7] St Orsola Hosp, Bologna, Italy

[8] Bolzano Hosp, Bolzano, Italy

[9] Brescia Hosp, Brescia, Italy

[10] Brotzu Hosp, Cagliari, Italy

[11] S Maria Annunziata Hosp, Chieti, Italy

[12] Cuneo Hosp, Cuneo, Italy

[13] Ferrara Univ Hosp, Ferrara, Italy

[14] Careggi Hosp, Florence, Italy

[15] Morgagni Hosp, Forli, Italy

[16] San Martino Hosp, Genoa, Italy

[17] Fazzi Hosp, Lecce, Italy

[18] C Poma Hosp, Mantua, Italy

[19] Mestre Hosp, Venice, Italy

[20] IRCCS Humanitas, Milan, Italy

[21] IEO Hosp, Milan, Italy

[22] Osped Niguarda Ca Granda, Milan, Italy

[23] Fdn IRCCS Ca Granda, Milan, Italy

[24] S Raffaele Hosp, Milan, Italy

[25] Modena Hosp, Modena, Italy

[26] S Gerardo Hosp, Monza, Italy

[27] Monaldi Hosp, Naples, Italy

[28] Maggiore Carita Hosp, Novara, Italy

[29] Univ Hosp Padova, Padua, Italy

[30] IRCCS ISMETT, Palermo, Italy

[31] Univ Hosp, Parma, Italy

[32] Univ Hosp, Perugia, Italy

[33] S Andrea Hosp, Rome, Italy

[34] Forlanini Hosp, Rome, Italy

[35] Gemelli Hosp, Rome, Italy

[36] Univ Hosp, Siena, Italy

[37] Mazzini Hosp, Teramo, Italy

[38] Molinette Mauriziano Hosp, Turin, Italy

[39] S Giovanni Bosco Hosp, Turin, Italy

[40] Osped S Maria Misericordia, Udine, Italy

[41] Varese Hosp, Varese, Italy

[42] Negrar Hosp, Verona, Italy

[43] Borgo Trento City Hosp, Verona, Italy

来源：

INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY | 2019年 / 29卷 / 05期

关键词：

Video-assisted thoracic surgery; Lobectomy; Uniportal; Three-portal; Postoperative pain; Italian VATS Group; THORACOSCOPIC LOBECTOMY; SINGLE-INCISION; PORT; PAIN;

D O I：

10.1093/icvts/ivz153

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES: This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS: This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I-II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale <= 3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS: Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P<0.001). There was a statistical difference on the second and third postoperative days; odds ratio (OR) 2.28 [95% confidence interval (CI) 1.62-3.21; P<0.001] and OR 2.58 (95% CI 1.74-3.83; P<0.001), respectively. The uniportal-VATS group had higher operative time (P<0.001), shorter chest drain permanence (P<0.001) and shorter length of stay (P<0.001). CONCLUSIONS: Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.

引用

页码：714 / 721

页数：8

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