| Sažetak | Objectives: The aim of this study was to determine the operation duration, chest drainage duration and length of postoperative hospital stay for lung cancer patients that underwent either uniportal VATS, multiportal VATS or open thoracotomy surgeries at the University Hospital of Split in the observed period. Furthermore, the study compared the three operation techniques, using the determined parameters, in order to investigate possible superiorities or inferiorities between them.
Subjects and Methods: From January 2016 until December 2018, 150 patients (94 males and 56 females) who underwent surgery for the treatment of lung cancer at the Department of Surgery, University Hospital of Split, were included in the retrospective study. Patients were divided according to the type of surgery they underwent. There were three main groups: Multiportal VATS (N=59), Uniportal VATS (N=32) and Open Thoracotomy (N=23). These groups were compared regarding operation duration, chest drainage duration and length of postoperative hospital stay. In addition, two subgroups for converted uniportal and multiportal VATS operations were formed.
Results: The median age of the included patients was 64 years (18-79 years). Most patients were operated by multiportal VATS (87), of which 28 operations had to be converted to an open operation. The second most frequent operation was uniportal VATS (40), with a total of 8 conversions needed. There was no statistical difference in the operation's respective conversion ratios (p=0.283). When comparing non-converted uniportal VATS and multiportal VATS with open thoracotomies there was no statistically significant difference between gender distribution(p=0.287), age (p=0.569), operation durations (p=0.093) or postoperative recovery times (p=0.086). The drainage duration was significantly longer in open thoracotomies (6 days) compared to the two minimally invasive operations (p=0.016). There was no difference between uniportal VATS (5 days) and multiportal VATS (5 days) with respect to drainage duration.
Conclusion: This study shows that minimally invasive operation techniques, namely multiportal and uniportal VATS, are in many cases better suited surgeries for the treatment of lung cancer than an open thoracotomy. This is in concordance with the findings of other recent studies and reflected in multiportal VATS being the gold standard of lung cancer treatment. However, there is no clear superiority of uniportal VATS over multiportal VATS to be observed, despite it`s even less invasive nature. On the other hand, the results also show no drawbacks between the two techniques, suggesting an equivalent clinical value of uniportal VATS in the treatment of lung cancer. |
| Sažetak (hrvatski) | Ciljevi: Cilj ovog rada bio je utvrditi trajanje operacije, trajanje drenaže prsnog koša i trajanje poslijeoperacijske hospitalizacije bolesnika s karcinomom pluća koji su podvrgnuti uniportalnom VATS-u, multiportalnom VATS-u i torakotomijskim postupcima u Kliničkom bolničkom centru Split, u promatranom razdoblju. Nadalje, koristeći utvrđene parametre, studija je uspoređivala tri operacijske tehnike u smislu moguće superiornosti ili inferiornosti među njima.
Ispitanici i metode: Od siječnja 2016. do prosinca 2018. u retrospektivnu studiju uključeno je 150 bolesnika (94 muškarca i 56 žena) koji su na kirurškom odjelu Kliničke bolnice Split podvrgnuti operaciji liječenja karcinoma pluća. Prema vrsti operacije kojoj su podvrgnuti, ispitanici su podijeljeni u tri glavne skupine: ispitanici liječeni multiportalnim VATS - om (N = 59), uniportalnim VATS - om (N = 32) i otvorenom torakotomijom (N = 23). Te skupine ispitanika uspoređene su s obzirom na trajanje operacije, trajanje drenaže prsnog koša i duljinu postoperativnog boravka u bolnici. Osim toga, formirane su dvije podskupine za konvertirane uniportalne i multiportalne VATS zahvate.
Rezultati: Medijan dobi uključenih ispitanika je 64 godine (18-79 godina). Većina ispitanika operirana je multiportalnim VATS-om (87), od čega je 28 operacija konvertirano u otvorenu operaciju. Druga najčešća operacija bila je uniportalni VATS (40), s ukupno 8 potrebnih konverzija. Nije dokazana statistički značajna razlika u stopi konverzije u otvorenu torakotomiju između dvije vrste VATS zahvata (p = 0,283). Pri usporedbi nekonvertiranih uniportalnih VATS i multiportalnih VATS zahvata s otvorenim torakotomijama nije bilo statistički značajne razlike između spolne raspodjele (p = 0,287), dobi (p = 0,569), trajanja operacije (p = 0,093) ili duljine poslijeoperacijske hospitlizacije (p = 0,086). Trajanje drenaže bilo je značajno duže u ispitanika s otvorenim torakotomijama (6 dana), u usporedbi s oba tipa minimalno invazivnih operacija (p = 0,016). Nije bilo razlike između uniportalnog VATS-a (5 dana) i multiportalnog VATS-a (5 dana) u odnosu na trajanje drenaže prsnog koša.
Zaključci: Ova studija pokazuje da su minimalno invazivne operacijske tehnike, odnosno multiportalni i uniportalni VATS, bolji izbor od otvorene torakotomije u kirurškom liječenju karcinoma pluća. To je u skladu s nalazima drugih nedavnih studija koje naglašavaju vrijednost tehnike multiportalnog VATS-a kao zlatnog standarda u liječenju karcinoma pluća. Međutim, ne postoji jasna superiornost uniportalnog VATS-a nad multiportalnim, iako je riječ još manje invazivnoj tehnici. S druge strane, rezultati također ne ukazuju niti nedostatke pojedine od ove dvije tehnike, što upućuje na ekvivalentnu kliničku vrijednost uniportalnog VATS-a u liječenju karcinoma pluća. |
