Uniportal versus multiportal video-assisted thoracic surgery (VATS) in esophageal cancer: A systematic review and meta-analysis.

Abstract

e16114 Background: Minimally invasive approaches are increasingly used in esophageal cancer surgery, but the relative benefits of uniportal versus multiportal video-assisted thoracic surgery (VATS) remain unclear. This study aimed to compare perioperative outcomes, complications, and survival between the two approaches.To compare the perioperative outcomes, postoperative complications, and survival of uniportal versus multiportal VATS in patients undergoing esophagectomy for esophageal cancer.To evaluate whether uniportal VATS offers clinical advantages in pain reduction, hospital stay, and complication rates. Methods: A systematic review and meta-analysis was performed including studies comparing uniportal and multiportal VATS in patients undergoing esophagectomy. Primary outcomes were postoperative pain (POD1, VAS), overall postoperative complications (Clavien–Dindo grade I–II), length of hospital stay, mortality, and overall survival. Secondary outcomes included postoperative pneumonia, anastomotic leakage, and operative time. Effect sizes were pooled using a random-effects model and reported as mean difference (MD), odds ratio (OR), or hazard ratio (HR) with 95% confidence intervals (CI). Heterogeneity was assessed using I². Results: Uniportal VATS was associated with significantly lower postoperative pain on POD1 compared with multiportal VATS (MD −1.89, 95% CI −3.47 to −0.31, p = 0.019; I² = 99.1%). A trend toward fewer overall postoperative complications was observed (OR 0.51, 95% CI 0.24–1.10, p = 0.088; I² = 54.6%), while length of hospital stay was significantly shorter in the uniportal group (MD −1.22 days, 95% CI −2.15 to −0.29, p = 0.010; I² = 96.3%). No significant differences were found in mortality (OR 1.63, 95% CI 0.20–13.34, p = 0.65; I² = 0%) or overall survival (HR 1.07, 95% CI 0.51–2.24, p = 0.87; I² = 0%). Among secondary outcomes, uniportal VATS significantly reduced postoperative pneumonia (OR 0.48, 95% CI 0.26–0.88, p = 0.017; I² = 35.4%), while anastomotic leakage rates were comparable (OR 0.56, 95% CI 0.22–1.40, p = 0.21; I² = 0%). Conclusions: Uniportal VATS for esophageal cancer is associated with lower early postoperative pain, reduced length of hospital stay, and fewer postoperative pneumonias, with comparable mortality, anastomotic leakage, and long-term survival relative to multiportal VATS. These findings support the safety and potential perioperative benefits of the uniportal approach.