Lung cancer represents the second malignancy in both men and women and the first cause of cancer-related mortality. Because of worldwide diffusion of lung cancer screening programs, major lung resections for initial stage diseases have been increasingly performed in past decades. Video-assisted thoracic surgery (VATS) emerged as a new and feasible approach representing a viable alternative to classic open thoracotomy. Between January 2017 and September 2018, we performed 130 VATS major lung resections with uniportal technique. We compared this sample to 48 previous or simultaneous lobectomies performed with a lateral thoracotomy (NO-VATS group). Total morbidity resulted significantly lower in the VATS group (p=0.0046). VATS technique resulted in a significant mean decrease in time of surgery of 20 minutes (p=0.013). We did not observe a significant difference in the number of nodes sampled. VATS technique resulted in an average of 3.57 days reduction in hospital stay (5.45 vs 9.02, 95% CI: 1.27-5.85; significant with t-test: p=0.0028). We compared post-operative pain among the two groups: we observed a small advantage for pain level in the VATS group, but without statistical significance. Surgical costs were significantly greater for VATS (p<0.05) while recovery costs were higher for NO-VATS (p<0.05). Overall costs resulted to be lower in the VATS group (significant with t-test, p=0.026). VATS showed same results in terms of oncological outcome compared to lateral thoracotomy. We observed an advantage in VATS group patients according to morbidity, pain level, hospital stay and overall costs.

Uniportal-VATS, Early stage lung cancer, Surgical morbidity, Costs analysis