Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery for Minimally Invasive Esophagectomy in Esophageal Cancer: A GRADE-Assessed Systematic Review and Meta-Analysis.

In 30 seconds

This GRADE-assessed systematic review and meta-analysis compared uniportal (uVATS) with multiportal video-assisted thoracoscopic surgery (mVATS) for minimally invasive esophagectomy in adults with esophageal cancer. Nine comparative studies were included, predominantly observational. uVATS was associated with less postoperative pneumonia (OR 0.41, 95% CI 0.22-0.76), lower day-one pain, and shorter hospital stay. The approaches did not differ significantly in anastomotic leakage, overall complications, recurrent laryngeal nerve injury, perioperative mortality, blood loss, or operative time. The authors describe uVATS as a feasible alternative, while noting substantial heterogeneity and limited evidence.

Key findings

• Postoperative pneumonia was lower with uVATS than mVATS (OR 0.41, 95% CI 0.22-0.76; I² = 43.5%).
• Day-one postoperative pain was lower with uVATS (MD - 2.10, 95% CI - 3.63 to - 0.57; I² = 99.3%).
• Hospital stay was shorter with uVATS (MD - 2.13 days, 95% CI - 3.64 to - 0.63; I² = 96.8%).
• No significant differences were found in anastomotic leakage, overall complications, recurrent laryngeal nerve injury, perioperative mortality, blood loss, or operative time.

Why it matters

The findings suggest that the number of thoracoscopic ports may be associated with differences in postoperative pain, pulmonary morbidity, and length of stay, without detected differences in several major safety outcomes. These comparisons may inform evaluation of surgical approaches, but high heterogeneity and the predominance of observational studies mean the apparent advantages should be interpreted cautiously.

What to keep in mind

The evidence was limited by high heterogeneity and a predominance of observational studies; the abstract also notes that comparative evidence came from small single-centre studies.