Single-port compared to multi-port video-assisted thoracoscopic esophagectomy: a propensity-matched study

The advent of minimally invasive techniques, such as video-assisted thoracoscopic surgery (VATS), has revolutionized esophageal cancer surgery by reducing surgical trauma, accelerating recovery, and improving postoperative quality of life. Multi-port VATS has emerged as a widely adopted approach, offering technical feasibility and oncological efficacy. However, recent advancements in minimally invasive surgery (MIS) have introduced single-port VATS, which further minimizes incisions and may enhance cosmetic outcomes, reduce postoperative pain, and shorten hospital stays. This study aimed to compare the perioperative indices between single-port VATS and multi-port VATS for esophageal cancer.

The clinical data of 443 patients undergoing minimally invasive three-field radical esophagectomy for esophageal cancer from 2018 to 2022 were retrospectively analyzed. Patients were divided into a single-port (n=224) and multi-port group (n=219), and perioperative indices including aesthetics, incision pain, hospitalization time, etc., in the two groups were analyzed and compared.

The total surgical time of the single-port group was significantly lower than that of the multi-port group (P<0.001), but there were no differences in thoracoscopic operation time (P=0.17), number of thoracic lymph nodes dissected (P=0.10), and number of lymph node sorting groups (P=0.51) between the two groups. The postoperative drainage volume (P<0.001) and drainage time (P=0.002) in the single-port group were lower compared with those in the multi-port group. Compared to the multi-port group, the single-port group had a significantly lower postoperative pain grade (P<0.001) and a significantly higher incision aesthetic score (P<0.001). There was no significant difference in the incidence of postoperative complications between the two groups (P=0.93). The hospitalization time of patients in the single-port group was significantly shorter than that in the multi-port group (P<0.001).

Single-port video-assisted thoracoscopic esophagectomy demonstrated superior incision aesthetics, reduced pain, and a shorter average hospitalization time.