Quality of life during the first 3 months after uniportal vs. multiportal video-assisted thoracoscopic lobectomy for lung cancer: a prospective cohort study.

BACKGROUND: The comparative effect of uniportal video-assisted thoracoscopic surgery (U-VATS) vs. multiportal video-assisted thoracoscopic surgery (M-VATS) on quality of life (QoL) during the first 3 months after lung cancer surgery remains uncertain. We compared longitudinal QoL after U-VATS and M-VATS lobectomy. METHODS: This prospective observational cohort study assessed QoL with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-LC29 questionnaires preoperatively and at 2, 4, 8, and 12 weeks after discharge. Longitudinal trajectories were evaluated using linear mixed-effects models in unweighted and inverse probability of treatment weighting (IPTW)-weighted analyses. RESULTS: Among 130 patients, 89 underwent U-VATS and 41 underwent M-VATS. Most symptom and functioning trajectories were similar. Fear of progression showed a group-by-time interaction in both analyses; social functioning differed in the IPTW-weighted analysis, whereas constipation differed in the unweighted analysis. Compared with M-VATS, U-VATS was associated with a shorter operative time (median, 85 vs. 120 min), shorter postoperative hospital stay (median, 4 vs. 6 days), and fewer Clavien-Dindo grade ≥2 complications within 3 months (10.1% vs. 39.0%). CONCLUSIONS: Most 3-month QoL trajectories were similar after U-VATS and M-VATS lobectomy. The observed domain-specific differences were exploratory and their clinical importance remains uncertain. U-VATS was associated with more favorable unadjusted perioperative outcomes, but residual confounding precludes causal interpretation.