{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:17:42Z","timestamp":1787807862275,"version":"build-2784847793"},"reference-count":30,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004606","name":"Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["CIRPG3M0031"],"award-info":[{"award-number":["CIRPG3M0031"]}],"id":[{"id":"10.13039\/501100004606","id-type":"DOI","asserted-by":"publisher"}]},{"award":["CIRPG3M0031"],"award-info":[{"award-number":["CIRPG3M0031"]}],"id":[{"id":"https:\/\/ror.org\/02verss31","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Objective: Subcostal uniportal robot-assisted thoracic surgery (URATS) using the da Vinci Single-Port (SP) system avoids intercostal placement of the main robotic access. This prespecified secondary analysis of a prospective trial characterized chronic postsurgical pain and health-related quality of life (HRQOL) as primary patient-reported outcomes after subcostal URATS for early-stage lung cancer, with mid-term oncological outcomes as an exploratory endpoint. Methods: Patients from the parent trial (NCT05535712) undergoing subcostal URATS were assessed at 3, 6, and 12 months by structured telephone interviews. Chronic postsurgical pain was defined by the ICD-11 criterion (Numerical Rating Scale [NRS] &gt; 0 on any of four activity-specific items). Neuropathic features were assessed with the painDETECT Questionnaire (PDQ), and HRQOL with EORTC QLQ-C30 summary score and selected domains. Results: In 33 patients, chronic postsurgical pain declined from 33.3% at 3 months to 6.1% at 12 months (p = 0.004), was mild among symptomatic patients (median NRS 1), and showed no PDQ-defined neuropathic features. Two patients received a 7-day course of gabapentin at 3 months. Baseline HRQOL (median QLQ-C30 summary score 91.5) increased at all postoperative time points (p &lt; 0.001). At a median 40-month follow-up, one patient had bilateral pulmonary recurrence at 13 months, all remained alive, and no delayed hernia or other access-related complication was identified. Conclusions: Subcostal URATS was feasible in this prospective cohort. Chronic postsurgical pain was mild and decreased over time, HRQOL remained well preserved, although data on mid-term oncological outcomes were preliminary.<\/jats:p>","DOI":"10.3390\/cancers18172763","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T15:55:06Z","timestamp":1787673306000},"page":"2763","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Health-Related Quality of Life and Mid-Term Oncological Outcomes After Subcostal Uniportal Robot-Assisted Lung Cancer Surgery: A Secondary Analysis of a Clinical Trial"],"prefix":"10.3390","volume":"18","author":[{"given":"Chuan","family":"Cheng","sequence":"first","affiliation":[{"name":"Division of Thoracic Surgery, New Taipei Municipal Tu-Cheng Hospital, New Taipei City 236017, Taiwan"},{"name":"Department of Artificial Intelligence, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 333323, Taiwan"},{"name":"Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333423, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya-Chun","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333423, Taiwan"},{"name":"Department of Nursing, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan 333423, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8649-8783","authenticated-orcid":false,"given":"Yin-Kai","family":"Chao","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333423, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.jtcvs.2017.02.008","article-title":"Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection","volume":"154","author":"Kwon","year":"2017","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e1348","DOI":"10.1097\/SLA.0000000000005387","article-title":"Long-term Functional Outcomes Among Older Adults Undergoing Video-assisted Versus Open Surgery for Lung Cancer: A Population-based Cohort Study","volume":"277","author":"Hallet","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1055\/s-0040-1715598","article-title":"Robotic-Assisted Lobectomy Favors Early Lung Recovery versus Limited Thoracotomy","volume":"69","author":"Lacroix","year":"2021","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Zhang, B., Xiao, Q., Xiao, H., Wu, J., Yang, D., Tang, J., Li, X., Wu, Z., Zhou, Y., and Wang, W. (2022). Perioperative Outcomes of Video-Assisted Thoracoscopic Surgery Versus Open Thoracotomy After Neoadjuvant Chemoimmunotherapy in Resectable NSCLC. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.858189"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3422","DOI":"10.21037\/jtd-24-158","article-title":"Post-thoracotomy pain syndrome in the era of minimally invasive thoracic surgery","volume":"16","author":"Miyazaki","year":"2024","journal-title":"J. Thorac. Dis."},{"key":"ref_6","first-page":"999","article-title":"Nerve changes associated with post thoracotomy pain syndrome","volume":"37","author":"Petrache","year":"2022","journal-title":"Histol. Histopathol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3582","DOI":"10.21037\/jtd-20-425","article-title":"Comparison of post-operative pain and quality of life between uniportal subxiphoid and intercostal video-assisted thoracoscopic lobectomy","volume":"12","author":"Chen","year":"2020","journal-title":"J. Thorac. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1097\/ALN.0000000000001576","article-title":"A Prospective Study of Chronic Pain after Thoracic Surgery","volume":"126","author":"Bayman","year":"2017","journal-title":"Anesthesiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1111\/j.1399-6576.2010.02357.x","article-title":"Consequences of persistent pain after lung cancer surgery: A nationwide questionnaire study","volume":"55","author":"Wildgaard","year":"2011","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ejcts.2005.02.039","article-title":"Uniportal vs standard three-port VATS technique for spontaneous pneumothorax: Comparison of post-operative pain and residual paraesthesia","volume":"28","author":"Jutley","year":"2005","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e13302","DOI":"10.1111\/ases.13302","article-title":"Factors related to post-thoracotomy pain following robotic-assisted thoracic surgery","volume":"17","author":"Tokuishi","year":"2024","journal-title":"Asian J. Endosc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1093\/icvts\/ivs446","article-title":"Total port-access lobectomy via a subcostal trans-diaphragmatic approach for lung cancer","volume":"16","author":"Oda","year":"2013","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1177\/15569845231217257","article-title":"Outside the Cage Subcostal RATS Lobectomy: Technical Aspects and Results of the First Series of a Novel Approach to Pulmonary Lobectomy","volume":"18","author":"Alashgar","year":"2023","journal-title":"Innovations"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/s11701-024-02108-0","article-title":"Pain outcomes of outside-the-cage robotic thoracic surgery: A prospective matched-cohort study","volume":"18","author":"Streit","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_15","first-page":"5906295","article-title":"Uniportal Subcostal Video-Assisted Thoracoscopic Surgery: A Feasible Approach for a Challenging Middle Lobectomy in an Obese Patient","volume":"2019","author":"Zhao","year":"2019","journal-title":"Case Rep. Pulmonol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Wu, C.F., Cheng, C., Suen, K.H., Stein, H., and Chao, Y.K. (2023). A Preclinical Feasibility Study of Single-Port Robotic Subcostal Anatomical Lung Resection and Subxiphoid Thymectomy Using the da Vinci\u00ae SP System. Diagnostics, 13.","DOI":"10.3390\/diagnostics13030460"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.xjtc.2023.05.013","article-title":"Single-port robotic right upper lobe lobectomy: A case report","volume":"20","author":"Cheng","year":"2023","journal-title":"JTCVS Tech."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.xjtc.2024.01.024","article-title":"Subcostal uniportal robotic anatomic lung resection: A pilot trial","volume":"25","author":"Cheng","year":"2024","journal-title":"JTCVS Tech."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1002\/wjs.12051","article-title":"Single-port robotic subcostal major pulmonary resection using the single-port robotic system","volume":"48","author":"Lee","year":"2024","journal-title":"World J. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.21037\/jtd-21-1739","article-title":"Initial experience with and surgical outcomes of da Vinci single-port system in general thoracic surgery","volume":"14","author":"Park","year":"2022","journal-title":"J. Thorac. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.jtcvs.2025.04.004","article-title":"Robotic-assisted single-port system for pulmonary lobectomy: A prospective feasibility study","volume":"170","author":"Zervos","year":"2025","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1007\/s11701-026-03420-7","article-title":"Less pain and earlier recovery after extra-thoracic single-port robotic lung resection: A propensity-matched comparison","volume":"20","author":"Pachos","year":"2026","journal-title":"J. Robot. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1097\/j.pain.0000000000001413","article-title":"The IASP classification of chronic pain for ICD-11: Chronic postsurgical or posttraumatic pain","volume":"160","author":"Schug","year":"2019","journal-title":"Pain"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1185\/030079906X132488","article-title":"painDETECT: A new screening questionnaire to identify neuropathic components in patients with back pain","volume":"22","author":"Freynhagen","year":"2006","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/j.jpain.2008.05.009","article-title":"Only half of the chronic pain after thoracic surgery shows a neuropathic component","volume":"9","author":"Steegers","year":"2008","journal-title":"J. Pain"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2260","DOI":"10.1016\/0959-8049(95)00296-0","article-title":"The EORTC core quality of life questionnaire (QLQ-C30): Validity and reliability when analysed with patients treated with palliative radiotherapy","volume":"31","author":"Kaasa","year":"1995","journal-title":"Eur. J. Cancer"},{"key":"ref_27","first-page":"113","article-title":"Combined aerobic exercise and high-intensity respiratory muscle training in patients surgically treated for non-small cell lung cancer: A pilot randomized clinical trial","volume":"55","author":"Marco","year":"2019","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.lungcan.2018.07.021","article-title":"EORTC QLQ-C30 summary score reliably detects changes in QoL three months after anatomic lung resection for Non-Small Cell Lung Cancer (NSCLC)","volume":"123","author":"Pompili","year":"2018","journal-title":"Lung Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Novellis, P., Maisonneuve, P., Dieci, E., Voulaz, E., Bottoni, E., Di Stefano, S., Solinas, M., Testori, A., Cariboni, U., and Alloisio, M. (2021). Quality of Life, Postoperative Pain, and Lymph Node Dissection in a Robotic Approach Compared to VATS and OPEN for Early Stage Lung Cancer. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081687"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"726","DOI":"10.2105\/AJPH.86.5.726","article-title":"Adjusting for multiple testing when reporting research results: The Bonferroni vs Holm methods","volume":"86","author":"Aickin","year":"1996","journal-title":"Am. J. Public Health"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/17\/2763\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T04:23:22Z","timestamp":1787804602000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/17\/2763"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":30,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["cancers18172763"],"URL":"https:\/\/doi.org\/10.3390\/cancers18172763","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]}}}