Efficacy and safety of uniportal VATS and open lobectomy in NSCLC(>3 cm):a propensity score-matched study

ZHANG Youming; WANG Haibing; YAO Jie

doi:10.3969/j.issn.1009-0460.2025.03.004

Abstract：Objective To compare the efficacy and safety of single-port video-assisted thoracoscopic surgery(uVATS)and thoracotomy lobectomy in the treatment of non-small cell lung cancer(NSCLC)with a tumor size of 3 cm.Methods A retrospective analysis was conducted on pathological T2-4N0-2M0 stage NSCLC patients who underwent radical surgery in our hospital from January 1,2021 to December 1,2024,including 72 patients who underwent uVATS surgery and 32 patients who underwent thoracotomy.Compare the perioperative and oncological outcomes of two methods.Kaplan-Meier method was performed to evaluate long-term survival rate.A balanced cohort of uVATS patients and thoracotomy patients were obtained by propensity score-matched(PSM)analysis.Results In the overall cohort,patients undergoing thoracotomy were younger(P=0.040)and a slightly lower proportion of patients with a history of comorbidities(P=0.049).After PSM,26 pairs of patients were produced,and their preoperative characteristics were balanced(P>0.05).Compared with the thoracotomy group,the uVATS group had slightly smaller tumor diameter before operation(P=0.007)and less intraoperative blood loss(P=0.009),and there was still a difference in the PSM cohort(P<0.05).Compared with the thoracotomy group,the uVATS group had less chest tube drainage(P=0.049),significantly shortened postoperative hospital stay(P<0.001),and lower risk of postoperative grade≥2 complications(P=0.028);These differences remained in the PSM cohort(P<0.05).The R0 resection rate of thoracotomy group was slightly higher than that of uVAST group,and the difference was not statistically significant(P>0.05).The median follow-up time of the whole group of patients was 12.0 months.The median OS of uVAST group and thoracotomy group were not reached,and the median RFS was similar,and the difference was not statistically significant(P>0.05).After PSM matching,the median follow-up time was 10.65 months.The median OS of both groups was not reached,and the median RFS was similar,and the difference was not statistically significant(P>0.05).In multivariate competing risk analysis,emphysema(HR=21.838,P=0.030)and R0 resection(HR=0.107,P=0.021)were factors affecting OS.Conclusion For patients with NSCLC>3 cm,uVATS lobectomy is a safe and feasible procedure that provides a good perioperative period and prognosis for patients.