Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: a meta-analysis of propensity score-matched patients

Abstract

Objectives: This meta-analysis aimed to compare the perioperative outcomes of video-assisted thoracic surgery (VATS) with open thoracotomy for propensity score-matched patients with early-stage non-small cell lung cancer (NSCLC).

Methods: Four relevant studies with propensity score-matched patients were identified from six electronic databases. Endpoints included perioperative mortality and morbidity, individual postoperative complications and duration of hospitalization.

Results: Results indicate that all-cause perioperative mortality was similar between VATS and open thoracotomy. However, patients who underwent VATS were found to have significantly fewer overall complications, and significantly lower rates of prolonged air leak, pneumonia, atrial arrhythmias and renal failure. In addition, patients who underwent VATS had a significantly shorter length of hospitalization compared with those who underwent open thoracotomy.

Conclusions: In view of a paucity of high-level clinical evidence in the form of large, well-designed randomized controlled trials, propensity score matching may provide the highest level of evidence to compare VATS with open thoracotomy for patients with NSCLC. The present meta-analysis demonstrated superior perioperative outcomes for patients who underwent VATS, including overall complication rates and duration of hospitalization.

Figure 1:

Forest plot of the RR of postoperative mortality after VATS vs open thoracotomy for NSCLC. The estimate of the RR of each trial corresponds to the middle of the squares, and the horizontal line shows the 95% CI. On each line, the numbers of events as a fraction of the total number allocated are shown for both treatment groups. For each subgroup, the sum of the statistics, along with the summary RR, is represented by the middle of the solid diamonds. A test of heterogeneity between the trials within a subgroup is given below the summary statistics.

Figure 2:

Forest plot of the RR of postoperative morbidity after VATS vs open thoracotomy for NSCLC. The estimate of the RR of each trial corresponds to the middle of the squares, and the horizontal line shows the 95% CI. On each line, the numbers of events as a fraction of the total number allocated are shown for both treatment groups. For each subgroup, the sum of the statistics, along with the summary RR, is represented by the middle of the solid diamonds. A test of heterogeneity between the trials within a subgroup is given below the summary statistics.

Figure 3:

(a) Forest plot of the RR of postoperative prolonged air leak after VATS vs open thoracotomy for NSCLC. The estimate of the RR of each trial corresponds to the middle of the squares, and the horizontal line shows the 95% CI. On each line, the numbers of events as a fraction of the total number allocated are shown for both treatment groups. For each subgroup, the sum of the statistics, along with the summary RR, is represented by the middle of the solid diamonds. A test of heterogeneity between the trials within a subgroup is given below the summary statistics. (b) Forest plot of the RR of postoperative pneumonia after VATS vs open thoracotomy for NSCLC. The estimate of the RR of each trial corresponds to the middle of the squares, and the horizontal line shows the 95% CI. On each line, the numbers of events as a fraction of the total number allocated are shown for both treatment groups. For each subgroup, the sum of the statistics, along with the summary RR, is represented by the middle of the solid diamonds. A test of heterogeneity between the trials within a subgroup is given below the summary statistics. (c) Forest plot of the RR of postoperative atrial arrhythmias after VATS vs open thoracotomy for NSCLC. The estimate of the RR of each trial corresponds to the middle of the squares, and the horizontal line shows the 95% CI. On each line, the numbers of events as a fraction of the total number allocated are shown for both treatment groups. For each subgroup, the sum of the statistics, along with the summary RR, is represented by the middle of the solid diamonds. A test of heterogeneity between the trials within a subgroup is given below the summary statistics. (d) Forest plot of the RR of postoperative renal failure after VATS vs open thoracotomy for NSCLC. The estimate of the RR of each trial corresponds to the middle of the squares, and the horizontal line shows the 95% CI. On each line, the numbers of events as a fraction of the total number allocated are shown for both treatment groups. For each subgroup, the sum of the statistics, along with the summary RR, is represented by the middle of the solid diamonds. A test of heterogeneity between the trials within a subgroup is given below the summary statistics.

Figure 4:

Forest plot of the standardized mean difference (SMD) of the duration of hospitalization after VATS vs open thoracotomy for NSCLC. The estimate of the SMD of each trial corresponds to the middle of the squares, and the horizontal line shows the 95% CI. A test of heterogeneity between the trials within a subgroup is given below the summary statistics.