Late Breaking Abstract - An updated meta-analysis of uniportal versus multiportal video-assisted thoracoscopic lobectomy for lung cancer

Background: Multiportal video-assisted thoracoscopic surgery (MVATS) has become the standard approach for treating patients with non-small cell lung cancer. Uniportal VATS (UVATS) has been proposed as an alternative minimally invasive approach. Aim: We reviewed the available literature on patients with lung cancer undergoing either UVATS or MVATS lobectomy to evaluate which procedure is superior in terms of perioperative outcomes and survival. Methods: We identified original research studies that evaluated perioperative and long-term outcomes of UVATS versus MVATS, from January 1990 to March 2020. The perioperative, along with the oncologic and long-term survival outcomes were calculated according to either a fixed and a random effect model, appropriately. The Q statistics and I2 statistic were used to test for heterogeneity among the studies. Results: Twenty studies were included (kappa=0.787; 95% CI: 0.659, 0.914). A total of 1,469 patients treated with UVATS and 3,231 treated with MVATS were incorporated. The incidence of complications was lower in patients treated with UVATS [OR: 0.76 (95% CI: 0.62, 0.93); p=0.008]. The chest tube duration was significantly lower in the UVATS group (WMD: -0.63 [95% CI: -1.03, -0.23]; p=0.002). L.O.S. was also lower in the UVATS patient group (WMD: -0.54 [-0.94, -0.13]; p=0.009), along with postoperative pain [WMD: -0.57 (95% CI: -0.97, -0.18); p=0.004]. No significant differences were found regarding the mean operative time, mean blood loss, the number of resected lymph nodes, the 30-day mortality, and the 1- and 3-year survival. Conclusion: UVATS is associated with enhanced outcomes and should be preferred when technically feasible.