Impact of single-port versus three-port video-assisted thoracic surgery lobectomy on postoperative pain and quality of life in early-stage non-small cell lung cancer patients: a meta-analysis

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OBJECTIVE: This meta-analysis aims to evaluate the impact of these two techniques on postoperative pain and quality of life in early-stage NSCLC patients. METHODS: A comprehensive literature search was conducted in PubMed, Cochrane Library, Web of Science, and CNKI databases. Randomized controlled trials and cohort studies comparing single-port and three-port VATS lobectomy for early-stage NSCLC were included. The primary outcomes were operating time, postoperative complications, and 24-hour postoperative visual analog scale (VAS) pain scores. The Newcastle-Ottawa Scale (NOS) was used to assess study quality. Meta-analysis was performed using random-effects models, and heterogeneity was assessed using the I² statistic. RESULTS: Fifteen studies involving 3,228 patients (801 in the single-port group and 2427 in the three-port group) were included. The meta-analysis revealed that single-port VATS lobectomy was associated with a longer operating time (SMD: 0.61, 95% CI: 0.29 to 0.93, p < 0.001) compared to the three-port approach. However, single-port VATS demonstrated a lower incidence of postoperative complications (RR: 0.73, 95% CI: 0.59 to 0.90, p < 0.001). There was no significant difference in 24-hour postoperative VAS pain scores between the two groups (SMD: 0.02, 95% CI: -1.41 to 1.45, p > 0.05), although substantial heterogeneity was observed (I² = 98.1%). CONCLUSION: This meta-analysis suggests that single-port VATS lobectomy may offer advantages in terms of reduced postoperative complications compared to the three-port approach, despite longer operating times. However, the impact on immediate postoperative pain remains inconclusive due to high heterogeneity among studies.