Comparison of patient-reported outcomes after uniportal versus multiportal video-assisted thoracoscopic sub-lobar resection.

With the development of video-assisted thoracoscopic surgery (VATS), similar survival outcomes were found between uniportal and multiportal approach. Previous studies have found that uniportal lobectomy could reduce postoperative symptom burden compared with multiportal lobectomy. However, whether this difference existed in patients who underwent sub-lobar resection remained unknown. Our study aimed to compare postoperative symptom burden between uniportal and multiportal sub-lobar resection. This study included patients who underwent sub-lobar resection via uniportal or multiportal approach. The Perioperative Symptom Assessment Lung questionnaire and electronic symptom monitoring system were utilized to collect symptom data. The primary outcome was symptom severity, defined as the proportion of patients with symptom scores exceeding 4 points. Secondary outcomes included mean symptom scores, complication rates, length of hospitalization stay, and other conventional clinical outcomes. The uniportal group had a significantly lower burden of pain (P=0.001), shortness of breath (P=0.03), and disturbed sleep (P=0.02) during hospitalization. The uniportal group also reported lower severity of pain (P=0.02), shortness of breath (P=0.007), disturbed sleep (P=0.005), and distress (P=0.003) within 1-month post-discharge, as well as a lower proportion of severe pain (P=0.007) and distress (P=0.001) between 1 and 3 months after discharge. The uniportal group also had a shorter postoperative length of hospital stay (3 vs. 3.4 days, P=0.01), operative time (1.9 vs. 2.2 hours, P<0.001), and less blood loss (9.5 vs. 16.9 mL, P<0.001). This study indicated that the uniportal approach had the potential to reduce symptom burden and produce better clinical outcomes in patients who underwent sub-lobar resection compared with the multiportal approach.