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Objectives: Surgery through a single port may be less painful because access is supplied by 1 intercostal nerve or more painful because multiple instruments are used in 1 port. We analyzed data collected from the video-assisted thoracoscopic surgery group of a randomized controlled trial to compare differences in pain up to 1 year., Methods: Groups were compared in a prespecified exploratory analysis using direct (regression) and indirect comparison (difference with respect to thoracotomy). In-hospital visual analogue scale pain scores were used, and analgesic ratios were calculated. After discharge, pain was evaluated using European Organization for Research and Treatment of Cancer Quality of Life Questionnaires-Core 30 scores up to 1 year., Results: From July 2015 to February 2019, we randomized 503 participants. After excluding 50 participants who did not receive lobectomy, surgery was performed using a single port in 42 participants (predominately by a single surgeon), multiple ports in 166 participants, and thoracotomy in 245 participants. No differences were observed in-hospital between single- and multiple-port video-assisted thoracoscopic surgery when modeled using a direct comparison, mean difference of -0.24 (95% CI, -1.06 to 0.58) or indirect comparison, mean difference of -0.33 (-1.16 to 0.51). Mean analgesic ratio (single/multiple port) was 0.75 (0.64 to 0.87) for direct comparison and 0.90 (0.64 to 1.25) for indirect comparison. After discharge, pain for single-port video-assisted thoracoscopic surgery was lower than for multiple-port video-assisted thoracoscopic surgery (first 3 months), and corresponding physical function was higher up to 12 months., Conclusions: There were no consistent differences for in-hospital pain when lobectomy was undertaken using 1 or multiple ports. However, better pain scores and physical function were observed for single-port surgery after discharge., Competing Interests: E.L. reports personal fees from Abbott Molecular, GlaxoSmithKline plc, Pfizer Inc, Novartis Pharmaceuticals UK Ltd, Medtronic plc/Covidien, Roche Diagnostics, Lilly Oncology, Boehringer Ingelheim, Medela, Johnson & Johnson/Ethicon, AstraZeneca, and Bristol-Myers Squibb; grants from Clearbridge BioMedics, Illumina, and Guardant Health; and grants and personal fees from ScreenCell outside the submitted work. In addition, E.L. has patents P52435GB and P57988GB issued to Imperial Innovations. T.B. reports personal fees from Johnson & Johnson, Medtronic plc, Medela, and AstraZeneca outside the submitted work. J.D. reports personal fees from Cambridge Medical Robotics, ArtiSential, and Medtronic plc/Covidien outside the submitted work. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (© 2024 The Author(s).)

Objective: Surgical mortality has traditionally been assessed at arbitrary intervals out to 1 year, without an agreed optimum time point. The aim of our study was to investigate the time-varying risk of death after lobectomy to determine the optimum period to evaluate surgical mortality rate after lobectomy for lung cancer., Methods: We performed a retrospective study of patients undergoing lobectomy for lung cancer at our institution from 2015 to 2022. Parametric survival models were assessed and compared with a nonparametric kernel estimate. The hazard function was plotted over time according to the best-fit statistical distribution. The time points at which instantaneous hazard rate peaked and stabilized in the 1-year period after surgery were then determined., Results: During the study period, 2284 patients underwent lobectomy for lung cancer. Cumulative mortality at 30, 90, and 180 days was 1.3%, 2.9%, and 4.9%, respectively. Log-logistic distribution showed the best fit compared with other statistical distribution, indicated by the lowest Akaike information criteria value. The instantaneous hazard rate was greatest during the immediate postoperative period (0.129; 95% confidence interval, 0.087-0.183) and diminishes rapidly within the first 30 days after surgery. Instantaneous hazard rate continued to decrease past 90 days and stabilized only at approximately 180 days., Conclusions: In-hospital mortality is the optimal follow-up period that captures the early-phase hazard during the immediate postoperative period after lobectomy. Thirty-day mortality is not synonymous to "early mortality," as instantaneous hazard rate remains elevated well past the 90-day time point and only stabilizes at approximately 180 days after lobectomy., Competing Interests: E.L. reports personal fees from Covidien, Roche, Lilly Oncology, Boehringer Ingelheim, Medela, Ethicon, AstraZeneca, Beigene, Roche, and BMS; grants and personal fees from ScreenCell; and grants from Clearbridge Biomedics, Illumina, and Guardant Health, outside the submitted work. In addition, E.L. has patents P52435GB and P57988GB issued to Imperial Innovations. E.L. is Chief Investigator for VIOLET NIHR HTA (13/04/03), MARS 2 NIHR HTA (15/188/31), and RAMON NIHR HTA (131306); and founder of My Cancer Companion Healthcare Companion, Ltd. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Crown Copyright © 2023 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery.)