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Meta-Analysis
. 2013 Dec 31;8(12):e82366.
doi: 10.1371/journal.pone.0082366. eCollection 2013.

Thoracoscopic lobectomy versus open lobectomy in stage I non-small cell lung cancer: a meta-analysis

Yi-xin Cai  1 , Xiang-ning Fu  1 , Qin-zi Xu  1 , Wei Sun  1 , Ni Zhang  1
Affiliations
Meta-Analysis

Thoracoscopic lobectomy versus open lobectomy in stage I non-small cell lung cancer: a meta-analysis

Yi-xin Cai et al. PLoS One. .

Abstract

The objective of the present meta-analysis was to evaluate the survival, recurrence rate, and complications in patients with stage I non-small cell lung cancer (NSCLC) who received video-assisted thoracoscopic surgery (VATS) or open lobectomy. A literature search was conducted on June 31, 2012 using combinations of the search terms video-assisted thoracic surgery, open thoracotomy, lobectomy, and non-small-cell lung cancer (NSCLC). Inclusion criteria were: 1) Compared video-assisted thoracic surgery (VATS) lobectomy with open lobectomy. 2) Stage I NSCLC. 2) No previous treatment for lung cancer. 4) Outcome data included 5-year survival rate, complication, and recurrence rate. Tests of heterogeneity, sensitivity, and publication bias were performed. A total of 23 studies (21 retrospective and 2 prospective) met the inclusion criteria. VATS was associated with a longer 5-year survival (odds ratio [OR] = 1.622, 95% confidence interval [CI] 1.272 to 2.069; P<0.001), higher local recurrence rate (OR = 2.152, 95% CI 1.349 to 3.434; P = 0.001), similar distant recurrence rate (OR = 0.91, 95% CI 0.33 to 2.48; P = 0.8560), and lower total complication rate (OR = 0.45, 95% CI 0.24 to 0.84; P = 0.013) compared to open lobectomy. VATS was also associated with lower rates arrhythmias, prolonged air leakage, and pneumonia but it did not show any statistical significance. Patients with stage I NSCLC undergoing VATS lobectomy had longer survival and fewer complications than those who received open lobectomy.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Forest plot of the 5-year survival rates of the VATS vs. open surgery groups.
OR, odd ratio; LB, lower boundary; UB, upper boundary; CI, confidence interval.
Figure 2
Figure 2. Sensitivity analysis of the influence of individual studies on pooled estimate for 5-year survival rate.
OR, odd ratio; LB, lower boundary; UB, upper boundary; CI, confidence interval.
Figure 3
Figure 3. Funnel plot of the standard error by mean difference for 5-year survival rate.
Figure 4
Figure 4. Forest plot for the VATS vs. open surgery groups.
(A) local recurrence and (B) distant recurrence rate. OR, odd ratio; LB, lower boundary; UB, upper boundary; CI, confidence interval.
Figure 5
Figure 5. Forest plot for the VATS vs. open surgery groups.
(A) total complications, (B) arrhythmias, (C) prolonged air leakage, and (D) pneumonia. OR, odd ratio; LB, lower boundary; UB, upper boundary; CI, confidence interval.
See this image and copyright information in PMC

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