Longitudinal patient-reported outcomes one year after uniportal versus multiportal thoracoscopic surgery for lung cancer

Abstract Background The debate over the superiority of uniportal video-assisted thoracoscopic surgery (VATS) (U-VATS) versus multiportal VATS (M-VATS) remains unresolved. Herein, we compared long-term patient-reported outcomes within one year after discharge. Methods We utilized data from a longitudinal prospective study on patients with lung cancer undergoing M-VATS and U-VATS. The covariates were balanced using propensity score matching (PSM). Longitudinal symptom severity and functional status were assessed monthly until one year post-discharge and compared between the groups. The outcomes were presented as the proportion of patients exhibiting clinically significant severe scores (≥ 7 points on 0–10 scales) in the Perioperative Symptom Assessment for Lung Surgery Scale. Results Among 1,000 patients included, 914 underwent U-VATS and 86 underwent M-VATS. After 1:2 PSM, 258 patients were matched with 172 patients in the U-VATS group and 86 in the M-VATS group. The U-VATS group reported less severe pain (relative risk = 2.87, 95% confidence interval: 1.12–7.37, p = 0.028) during the first year after discharge compared with the M-VATS group. However, no significant differences were observed between the groups regarding distress, shortness of breath, cough, fatigue, drowsiness, disturbed sleep, difficulty in walking, and activity limitation (all p˃0.05). The U-VATS group reported shorter operative time, length of stay, chest tube duration, and postoperative length of stay; less operative blood loss and total drainage; and lower 30- and 90-day complication rates after surgery than the M-VATS group (all p˂0.05). Conclusions Patients undergoing U-VATS may experience less severe pain during the first year after discharge compared with those undergoing M-VATS. Trial registration ChiCTR2000033016, 2020.05.18