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Uniportal video-assisted thoracoscopic surgery reduces postoperative pain, pneumonia, and hospital stay in esophageal cancerOne-Port Surgery May Reduce Pain and Stay for Esophageal Cancer

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Key Takeaway
Consider uVATS as a feasible alternative to mVATS, potentially reducing postoperative pain and pneumonia risk.

This meta-analysis evaluates the clinical outcomes of uniportal video-assisted thoracoscopic surgery (uVATS) compared to multiportal video-assisted thoracoscopic surgery (mVATS) in adults undergoing minimally invasive esophagectomy for esophageal cancer. The analysis synthesized data on several postoperative and intraoperative metrics to determine the feasibility and safety of the uniportal approach.

The meta-analysis found that uVATS was associated with significantly lower postoperative pain on day one (MD -2.10; 95% CI -3.63 to -0.57) and a reduced risk of postoperative pneumonia (OR 0.41; 95% CI 0.22-0.76) compared to mVATS. Additionally, patients undergoing uVATS had a shorter length of hospital stay (MD -2.13 days; 95% CI -3.64 to -0.63). No significant differences were found between the two techniques regarding anastomotic leakage, overall complications, recurrent laryngeal nerve injury, perioperative mortality, intraoperative blood loss, or total operative time.

The authors note that the evidence base is limited by high heterogeneity and a predominance of observational studies. While uVATS appears to be a feasible and safe alternative to mVATS with potential benefits in pain management and pulmonary morbidity, the limited evidence base and lack of significant differences in major safety outcomes suggest it is not yet established as a definitive standard of care.

How this fits prior evidence

This meta-analysis addresses a gap in surgical technique comparison for esophageal cancer. While prior evidence identifies physical frailty as a top risk factor for pneumonia after esophagectomy, this finding suggests that uVATS may specifically reduce the incidence of postoperative pneumonia (OR 0.41) compared to multiportal techniques. The study provides a comparison of surgical approaches rather than systemic treatments or risk factor identification.

Researchers compared two types of minimally invasive surgery for patients with esophageal cancer. One method uses a single port (uVATS), while the other uses multiple ports (mVATS). The study looked at how these two methods affected recovery, safety, and time in the hospital.

The results showed that patients who had the single-port surgery experienced significantly less pain on their first day after surgery. These patients also had a lower risk of developing pneumonia and spent fewer days in the hospital. However, there were no significant differences between the two methods regarding major risks, such as lung injury, blood loss, or total surgery time.

Because the evidence comes from a mix of studies with high variety, the findings are not definitive. While the single-port method appears to be a safe and feasible option, the limited amount of data means it is not yet the established standard of care. Patients should discuss these options with their surgical team to determine the best approach for their specific needs.

What this means for you:
Single-port surgery for esophageal cancer may reduce pain and hospital stay while maintaining similar safety levels.

Common questions

How does single-port surgery compare to multi-port surgery for pain?

Patients who underwent single-port surgery (uVATS) reported significantly lower pain on their first day after surgery compared to those who had multi-port surgery (mVATS). The data showed a mean difference of -2.10 in pain scores for the single-port group.

Are there different risks for these two surgical methods?

The study found no significant differences between the two methods regarding major safety concerns. Both methods showed similar results for overall complications, blood loss, and nerve injuries. The evidence suggests that single-port surgery is a safe and feasible alternative to multi-port surgery.

Does the type of surgery affect how long a patient stays in the hospital?

Patients who received the single-port surgery stayed in the hospital for a shorter amount of time. The study found a mean difference of -2.13 days for those undergoing the single-port procedure compared to the multi-port method.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
BACKGROUND: Minimally invasive esophagectomy has become the preferred surgical approach for esophageal cancer, with uniportal video-assisted thoracoscopic surgery (uVATS) emerging as a potential refinement over conventional multiportal VATS (mVATS). However, comparative evidence remains limited to small single-centre studies. This systematic review and meta-analysis aimed to comprehensively evaluate perioperative and safety outcomes of uVATS versus mVATS in patients undergoing minimally invasive esophagectomy. METHODS: A systematic search was conducted across PubMed/MEDLINE, Embase, Scopus, Cochrane Library, Web of Science, ClinicalTrials.gov, and CNKI from inception through April 2026. Studies directly comparing uVATS with mVATS in adults undergoing minimally invasive esophagectomy were eligible. Binary outcomes were pooled as odds ratios and continuous outcomes as mean differences under REML random-effects model. Heterogeneity was assessed using I² statistics. Certainty of evidence was evaluated using the GRADE framework. RESULTS: Nine studies comparing uVATS and mVATS were included. uVATS was associated with significantly lower postoperative pain on day one (MD - 2.10, 95% CI - 3.63 to - 0.57; I² = 99.3%), reduced postoperative pneumonia (OR 0.41, 95% CI 0.22-0.76; I² = 43.5%), and shorter length of hospital stay (MD - 2.13 days, 95% CI - 3.64 to - 0.63; I² = 96.8%). No significant differences were observed between approaches for anastomotic leakage (OR 1.13, 95% CI 0.61-2.09), overall complications (OR 0.79, 95% CI 0.47-1.32), recurrent laryngeal nerve injury (OR 0.89, 95% CI 0.43-1.85), perioperative mortality (OR 0.53, 95% CI 0.16-1.81), intraoperative blood loss, or total operative time. CONCLUSION: UVATS esophagectomy appears to be a feasible and safe alternative to mVATS, with potential advantages in postoperative pain, pulmonary morbidity, and hospital stay while maintaining comparable perioperative safety. The evidence base remains limited by high heterogeneity and predominance of observational studies. Multicenter randomized trials with standardized protocols and long-term oncologic follow-up are needed to consolidate these findings.
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