Safety and feasibility of uniportal VATS for lung metastasectomy and mediastinal lymph node sampling, a single center experience

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Introduction: Lung metastases are a significant challenge in oncology indicating advanced disease and requiring complex treatments. Uniportal VATS (U-VATS) could offer advantages with comparable oncologic outcomes to traditional methods. Mediastinal lymph node(LN) staging during lung metastasectomy (LM) remains an area of ambiguity. Our primary endpoint is to demonstrate the safety and feasibility of U-VATS for LM and mediastinal LN sampling. Methods: From Apr 2023 to Dec 2024 all patients (Pts.) with LM collected from prospective maintained hospital database have been reviewed. We analyzed demographic data, clinical stage, type of primary disease, preoperative PET CT, metastasis characteristics, and surgical outcomes. We assessed complications, hospital stay, resection type, LN sampling, and pathological stage. The inclusion criteria required that the procedure be initiated and completed using the U-VATS technique. Results: 12 Pts. (10M, 2F; mean age 41yo, range 17–62) were included. Primary tumors: 7 sarcoma, 2 colorectal cancer, 1 renal cell carcinoma, and 1 head and neck cancer. 4 Pts. received chemotherapy before surgery. Wedge resection was performed in 11 Pts.; 1 patient underwent lingulectomy and 1 segmentectomy. Mean surgery duration was 130.5 minutes (range 60–193). LN were taken from stations V, VII, IX, and X and were all negative. 2 Pts. had prolonged air leaks. Hospital stay ranged from 1 to 5 days (mean 2.8 days). Hospital mortality was 0. All Pts. have been followed to 31 December 2024. Conclusion: Uniportal VATS for LM and mediastinal LN sampling is promising, safe and feasible, with low complication rates and short hospital stays.

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