Opioid use and symptom burden after uniportal video-assisted thoracoscopic surgery for early-stage non-small cell lung cancer: a longitudinal, propensity score-matched study

Optimal perioperative pain management is crucial after lung resection. It remains unclear whether minimally invasive surgical extents, such as segmentectomy versus lobectomy, affect postoperative opioid exposure and symptom burden. Data from the prospective CN-PRO-Lung 3 cohort were analyzed, including patients undergoing minimally invasive segmentectomy or lobectomy for peripheral ≤ 2 cm Tis–T1bN0 non-small cell lung cancer. Propensity score matching (PSM) minimized baseline differences. The primary outcome was postoperative opioid exposure during hospitalization (yes/no). Secondary outcomes included cumulative in-hospital oral morphine equivalent (OME) consumption, daily opioid exposure, patient-reported symptom burden, functional interference, and perioperative metrics. A total of 491 patients underwent minimally invasive segmentectomy ( n = 322) or lobectomy ( n = 169). After 1:1 PSM, 144 matched pairs were identified. Postoperatively, a significantly smaller proportion of patients in the segmentectomy group received opioids during hospitalization compared with the lobectomy group (45.1% vs. 63.9%, P = 0.001). Consistent with this finding, postoperative OME dose among opioid recipients was lower in the segmentectomy group (median 36 mg [IQR, 24–50] vs. 48 mg [IQR, 36–84], P = 0.002). In the sensitivity analysis including all matched patients and assigning 0 mg to patients without postoperative opioid exposure, the median postoperative OME dose remained lower in the segmentectomy group (0 mg [IQR, 0–36] vs. 36 mg [IQR, 0–49], P < 0.001). Secondary analyses showed a lower proportion of patients receiving opioids in the segmentectomy group from POD0 to POD4. Intraoperative OME use was lower in the segmentectomy group in the primary analysis (80.20 mg [IQR, 62.48–106.08] vs. 88.08 mg [IQR, 70.28–113.00], P = 0.021), but this difference was no longer significant in the sensitivity analysis excluding remifentanil. Exploratory PRO analyses suggested lower short-term symptom burden in the segmentectomy group, including pain, shortness of breath, disturbed sleep, and distress. Segmentectomy was associated with lower in-hospital opioid administration. Exploratory analyses suggested lower short-term symptom burden, but these findings should be interpreted cautiously given the observational design and non-standardized analgesic practice. ChiCTR2000033016 ( https://www.chictr.org.cn/searchprojEN.html ).