Clinical characteristics and surgical outcomes of uniportal video-assisted thoracoscopic surgery for lung cancer patients with concomitant pulmonary tuberculosis: a retrospective cohort study.

BACKGROUND

The coexistence of lung cancer and pulmonary tuberculosis (TB) presents substantial surgical challenges. This study aimed to analyze the clinical characteristics and evaluate the surgical outcomes of uniportal video-assisted thoracoscopic surgery (U-VATS) in lung cancer patients with concomitant pulmonary TB compared with those without TB.

METHODS

This retrospective cohort study reviewed medical records of patients who underwent U-VATS for primary lung cancer between January 2020 and October 2025. Patients were categorized into the tuberculosis group (lung cancer with concomitant pulmonary TB, n=106) and the control group (lung cancer without tuberculosis, n=104). Baseline demographics, clinical characteristics, intraoperative parameters, postoperative recovery indices, complications, and short-term oncological outcomes were compared. Continuous variables were analyzed using Student's t-test or the Mann-Whitney U test, and categorical variables were compared using the Chi-squared test or Fisher's exact test where appropriate.

RESULTS

A total of 210 patients were enrolled. No significant differences were observed in age, sex distribution, or tumor size between groups. The tuberculosis group exhibited a higher proportion of upper lobe lesions (64.2% vs. 51.0%, P=0.053) and significantly more pleural adhesions (72.6% vs. 34.6%, P<0.001). Intraoperatively, the tuberculosis group demonstrated significantly prolonged operative time (168.58±40.14 vs. 142.72±30.34 minutes; mean difference =25.86 minutes, P<0.001) and increased estimated blood loss (125.21±66.24 vs. 97.45±54.44 mL; mean difference =27.76 mL, P=0.001). Conversion to thoracotomy rates were comparable (4.7% vs. 2.9%, P=0.72). The number of dissected lymph nodes showed no significant difference (14.82±4.73 vs. 15.33±4.30, P=0.42). Postoperatively, the tuberculosis group exhibited longer chest tube drainage duration (5.36±2.77 vs. 4.21±2.01 days, P=0.001) and extended hospital stay (8.78±2.96 vs. 7.29±2.69 days, P<0.001). Overall complication rates were similar (18.9% vs. 14.4%, P=0.39), with no perioperative mortality. R0 resection was achieved in 98.1% and 99.0% of patients in the tuberculosis and control groups, respectively (P>0.99).

CONCLUSIONS

U-VATS is technically feasible and oncologically safe for lung cancer patients with concomitant pulmonary TB, despite increased operative complexity manifested by prolonged surgical time and extended postoperative recovery. Meticulous preoperative evaluation and experienced surgical technique are essential for optimal outcomes in this challenging patient population.