Video-assisted thoracoscopic surgery versus muscle-sparing thoracotomy for non-small cell lung cancer: a systematic review and meta-analysis

Abstract

Background It has been widely accepted that video-assisted thoracoscopic surgery (VATS) lobectomy is superior to conventional open thoracotomy lobectomy in many aspects. However, the direct comparison between VATS and Muscle-sparing thoracotomy (MST) has not been widely conducted. We aimed to compare the perioperative outcomes in non-small cell lung cancer (NSCLC) patients following VATS and MST. Methods PubMed, EMBASE, the Cochrane Library and Web of Science were searched for relevant studies. The retrieval time was up to April 24, 2019. Studies investigating the comparison of video-assisted thoracoscopy and muscle-sparing thoracotomy were included in our meta-analysis. Odds ratio and mean differences with 95% confidential interval were applied to determine the effectiveness of dichotomous or continuous variables respectively. Results A total of 10 studies were included with 1514 patients. Compared with MST, the incidence of postoperative complications in VATS [OR = 0.54; 95%CI(0.4, 0.73); P < 0.001] and the hospital stay [MD = -1.5; 95%CI(− 2.28, − 0.73); P = 0.0001] decreased significantly, chest tube drainage time [MD = -0.71; 95%CI(− 1.18, − 0.24); P = 0.003] were shorter and the intraoperative blood loss [MD = − 43.87; 95%CI(− 73.66, − 14.08); P = 0.004] were less in VATS group. VATS also showed a relatively longer operative time [MD = 17.11; 95%CI(2.38, 31.85); P = 0.02]. However, no significant differences were observed in numbers of resected lymph nodes, postoperative mortality, postoperative pneumonia and postoperative bleeding. Conclusion Compared with MST, VATS was associated with lower incidence of postoperative complications, shorter length of hospital stay, less intraoperative blood loss and less chest tube drainage, which showed that VATS was a comparable method to MST. Meanwhile, these results should be further conformed by more randomized control trials.

Surgical Site Infections Are Associated With Higher Blood Loss and Open Access in General Thoracic Practice

“…This results in longer operating times and higher intraoperative complication rates during that learning period (6). Its use in oncological procedures was a controversial subject until proven otherwise (8,(19)(20)(21)(22). With experience, operation durations tend to be lower with less intraoperative complications (8,19,20).…”

“…Its use in oncological procedures was a controversial subject until proven otherwise (8,(19)(20)(21)(22). With experience, operation durations tend to be lower with less intraoperative complications (8,19,20). Recent studies report fewer postoperative complications, shorter hospital stay, and shorter chest tube duration without compromising oncological outcomes in VATS (8,19,23).…”

Minimal invasive surgery in locally advanced N2 non-small cell lung cancer

“…The comparison between thoracoscopy and thoracotomy was also studied in a recent meta-analysis by Wang et al, reviewing the most reliable evidence (29). The pooled analysis of 10 studies and 1,514 patients showed a significant reduction of almost 46% in the incidence of total postoperative complications (odds ratio 0.54, P<0.0001) using VATS.…”

Robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy

“…Thoracotomy is still the main approach to perform lobectomy for early stage NSCLC: between 2010 and 2012, 67% of lobectomies were performed by open thoracotomy, 26% by VATS, and 7% by RATS, as registered in the USA nationwide cancer database [16] . VATS for early stage NSCLC is now well accepted, with better short-term outcomes [17,18] [ Table 1]. With VATS, a fissureless technique is preferred and mediastinal lymph node dissection is done at the end of the procedure.…”