Comparison of Subxiphoid and Intercostal Uniportal Video-Assisted Thoracoscopic Surgery for Early Thymoma, Lung Cancer, and Pneumothorax: A Retrospective Single-Center Study.

Abstract

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique for early thymoma, early-stage non-small cell lung cancer (NSCLC), and primary spontaneous pneumothorax (PSP). The subxiphoid uniportal VATS (SU-VATS) approach offers potential advantages over the intercostal uniportal VATS (IU-VATS) by reducing nerve injury and postoperative pain. A single-center retrospective study at The Fifth Hospital of Ganzhou included 756 patients who underwent SU-VATS or IU-VATS between January 2018 and September 2024. The propensity score matching (1:1) resulted in two cohorts of 192 patients each. Primary outcomes were inflammatory markers (Hs-CRP and WBCs) on postoperative day 1 (POD1) and visual analog scale (VAS) pain scores on POD1, POD3, POD7, and POD30. Secondary outcomes included operative time, blood loss, drainage duration, hospital stay, and complications. SU-VATS significantly reduced Hs-CRP (5.35 vs. 9.65 mg/L, p < 0.001) and WBCs (6.48 vs. 10.67 × 10⁹/L, p = 0.004) on POD1. VAS scores were lower in SU-VATS on POD1 (1.48 vs. 3.21, p < 0.001), POD3 (1.19 vs. 2.73, p < 0.001), and POD7 (1.07 vs. 1.86, p < 0.001), with no difference by POD30 (0.32 vs. 0.36, p = 0.160). Operative time, blood loss, drainage duration, hospital stay, and complication rates were similar between groups. SU-VATS reduces early postoperative inflammation and pain without compromising operative efficiency or safety compared to IU-VATS. These findings support adopting the subxiphoid approach as a preferred minimally invasive technique in thoracic surgery.