Systematic review and meta-analysis of uniportal versus multiportal video-assisted thoracoscopic lobectomy for lung cancer

Abstract

Background: Uniportal video-assisted thoracoscopic surgery (VATS) has emerged as a less invasive alternative to the conventional multiportal approach in the treatment of lung cancer. The benefits of this uniportal technique have not yet been characterized in patients undergoing VATS lobectomy. This meta-analysis aimed to compare the clinical outcomes of uniportal and multiportal VATS lobectomy for patients with lung cancer.

Methods: A systematic review was conducted using seven electronic databases. Endpoints for analysis included perioperative mortality and morbidity, operative time, length of hospital stay, perioperative blood loss, duration of postoperative drainage and rates of conversion to open thoracotomy.

Results: Eight relevant observational studies were identified and included for meta-analysis. Results demonstrated a statistically significant reduction in the overall rate of complications, length of hospital stay and duration of postoperative drainage for patients who underwent uniportal VATS lobectomy. There were no significant differences between the two treatment groups in regard to mortality, operative time, perioperative blood loss and rate of conversion to open thoracotomy.

Conclusions: The present meta-analysis demonstrated favourable outcomes for uniportal VATS lobectomy in the treatment of lung cancer compared to the conventional multiportal approach. However, long-term follow-up data is still needed to further characterize the benefits of the uniportal approach.

Keywords: Uniportal; lobectomy; lung cancer; meta-analysis; video-assisted thoracoscopic surgery (VATS).

Figure 1

PRISMA flow chart for literature search.

Figure 2

Forest plot of length of stay for uniportal and multiportal groups. The estimate of the mean difference of each study corresponds to the middle of the squares and the horizontal line shows the 95% confidence interval (CI). On each line, the mean and standard deviations are shown for both treatment groups. The sum of the statistics, along with the summary standardized mean difference, 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

Forest plot of duration of postoperative drainage for uniportal and multiportal groups. The estimate of the mean difference of each study corresponds to the middle of the squares and the horizontal line shows the 95% confidence interval (CI). On each line, the mean and standard deviations are shown for both treatment groups. The sum of the statistics, along with the summary standardized mean difference, 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 overall morbidity for uniportal and multiportal groups. The estimate of the mean difference of each study corresponds to the middle of the squares and the horizontal line shows the 95% confidence interval (CI). On each line, the mean and standard deviations are shown for both treatment groups. The sum of the statistics, along with the summary standardized mean difference, 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.