Comparison of Subxiphoid and Intercostal Uniportal Video-Assisted Thoracoscopic Surgery for Early Thymoma, Lung Cancer, and Pneumothorax: A Retrospective Single-Center Study.

IF 2.5 3区医学 Q2 SURGERY

World Journal of Surgery Pub Date : 2025-10-01 Epub Date: 2025-08-22 DOI:10.1002/wjs.70065

Guang-Zhi Kuang, Hai Hu, Song-Mao Ouyang, Jun-Tao Tan

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引用次数: 0

Abstract

Background: Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique for early thymoma, early-stage non-small cell lung cancer (NSCLC), and primary spontaneous pneumothorax (PSP). The subxiphoid uniportal VATS (SU-VATS) approach offers potential advantages over the intercostal uniportal VATS (IU-VATS) by reducing nerve injury and postoperative pain.

Methods: A single-center retrospective study at The Fifth Hospital of Ganzhou included 756 patients who underwent SU-VATS or IU-VATS between January 2018 and September 2024. The propensity score matching (1:1) resulted in two cohorts of 192 patients each. Primary outcomes were inflammatory markers (Hs-CRP and WBCs) on postoperative day 1 (POD1) and visual analog scale (VAS) pain scores on POD1, POD3, POD7, and POD30. Secondary outcomes included operative time, blood loss, drainage duration, hospital stay, and complications.

Results: SU-VATS significantly reduced Hs-CRP (5.35 vs. 9.65 mg/L, p < 0.001) and WBCs (6.48 vs. 10.67 × 10⁹/L, p = 0.004) on POD1. VAS scores were lower in SU-VATS on POD1 (1.48 vs. 3.21, p < 0.001), POD3 (1.19 vs. 2.73, p < 0.001), and POD7 (1.07 vs. 1.86, p < 0.001), with no difference by POD30 (0.32 vs. 0.36, p = 0.160). Operative time, blood loss, drainage duration, hospital stay, and complication rates were similar between groups.

Conclusions: SU-VATS reduces early postoperative inflammation and pain without compromising operative efficiency or safety compared to IU-VATS. These findings support adopting the subxiphoid approach as a preferred minimally invasive technique in thoracic surgery.

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剑下胸腔镜与肋间胸腔镜治疗早期胸腺瘤、肺癌和气胸的比较：一项回顾性单中心研究。

背景：视频胸腔镜手术（VATS）是一种治疗早期胸腺瘤、早期非小细胞肺癌（NSCLC）和原发性自发性气胸（PSP）的微创技术。通过减少神经损伤和术后疼痛，剑突下单门静脉麻醉（SU-VATS）入路比肋间单门静脉麻醉（IU-VATS）具有潜在的优势。方法：赣州市第五医院的一项单中心回顾性研究纳入了2018年1月至2024年9月期间接受SU-VATS或IU-VATS治疗的756例患者。倾向评分匹配（1:1）产生两个队列，每个队列192例患者。主要结果是术后第1天（POD1）的炎症标志物（Hs-CRP和wbc）和视觉模拟评分（VAS）在POD1、POD3、POD7和POD30上的疼痛评分。次要结局包括手术时间、出血量、引流时间、住院时间和并发症。结果：SU-VATS显著降低了POD1患者Hs-CRP （5.35 vs. 9.65 mg/L, p 9/L, p = 0.004）。结论：与IU-VATS相比，SU-VATS在不影响手术效率和安全性的情况下减少了术后早期炎症和疼痛。这些发现支持采用剑突下入路作为胸外科首选的微创技术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Surgery 医学-外科

CiteScore

5.10

自引率

3.80%

发文量

460

审稿时长

3 months

期刊介绍： World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.