International Society for Minimally Invasive Cardiothoracic Surgery

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Thoracoscopic Pneumonectomy For Non-squamous Non-small Cell Lung Cancer: Results Of Comparative Trial
Ivan Borovkov1, Pavel Kononets1, Dmitry Sekhniaidze2.
1N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation, 2Oncology Hospital No. 62, Moscow, Russian Federation.

BACKGROUND: Minimally invasive techniques are proved to be safe and effective in lung-sparing surgical treatment of non-small cell lung cancer. The question still remains whether these approaches are fully suitable for patients undergoing pneumonectomy. METHODS: Data from minimally invasive pneumonectomy patients were compared to those from patients who received thoracotomy on an intention-to-treat basis. Univariate and multivariate regression analyses were performed to identify the correlation between surgical approach and early postoperative morbidity, length of stay, number of dissected lymph nodes and rate of R0-resections. RESULTS: A total of 100 patients were included in study between 2016 and 2023, of which 51 underwent open pneumonectomy and 49 - minimally invasive pneumonectomy, including both UniPort (n=20) and MultiPort (n=29) techniques. The use of thoracoscopic approach was associated with reduced rate of postoperative complications in comparison to open surgery (26,5% and 39.2%; p=0,177) and lower mean length of stay (11,47 days and 15,16 days; p=0,086), but differences did not reach the statistical significance boundary (p ≤ 0,05). No difference was noted in number of dissected lymph nodes (19,1 and 21,9; p=0,06) and rate of R0-resections (100% and 94,1%; p=0,226). Besides, MultiPort approach correlated with increased number of removed lymph nodes (24,85 and 17,10; p=0,005) and higher duration of surgery (248 min. and 187 min.; p=0,005) when among UniPort pneumonectomy patients. No difference was found in terms of postoperative complications between these two subgroups.
CONCLUSIONS: Minimally invasive approaches in pneumonectomy patients do not compromise short-term outcomes and provide equivalent oncological effectiveness to open surgery.
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