Uniportal Lung Cancer Surgery: State of the Evidence.

Background: Uniportal video-assisted thoracic surgery (VATS) has generated much attention in recent years, but questions remain regarding the adequacy of evidence to support its use in lung cancer surgery. This review aims to explore what the currently published literature suggests the role of the uniportal approach may be and to critically appraise that literature.

Methods: A systematic review was conducted using the Ovid Medline database to identify articles related to uniportal VATS. Articles were selected for review on the basis of ability to provide original clinical data on the role of uniportal VATS for lung cancer surgery.

Results: The literature search revealed that only some publications on uniportal VATS provided original clinical data. Twenty-two articles were selected for review, including 9 case series and 13 comparative studies. No concerns about the safety of the uniportal VATS were noted. Some but not all comparative studies provided data suggesting that uniportal VATS may hold advantages over multiportal VATS in some simple clinical outcomes (such as reduced lengths of stay and postoperative pain). However, the quantity and quality of evidence thus far are limited.

Conclusions: It remains premature to declare superiority for uniportal VATS in lung cancer surgery. A higher level of evidence is needed, especially in investigating objective benefits and treatment efficacy of the single-incision approach.