A systematic review and meta-analysis of thoracoscopic versus thoracotomy sleeve lobectomy

Abstract

Background: Operative safety and oncologic adequacy of thoracoscopic sleeve lobectomy remain controversial. As such, the purpose of this meta-analysis was to evaluate evidence comparing thoracoscopy and thoracotomy in sleeve lobectomy for centrally located non-small cell lung cancer (NSCLC).

Methods: Electronic searches of PubMed and Web of Science databases were undertaken from inception to March 2020. Comparative studies about thoracoscopic and thoracotomy sleeve lobectomy, with evaluation for perioperative outcomes and oncological results were identified. The following outcomes were measured in this meta-analysis: operating time, blood loss, numbers of lymph node, postoperative hospital stay, chest drainage time, postoperative complication rate, mortality, overall survival (OS). The standardized difference (SMD), relative risk (RR) and hazard ratio (HR) with 95% confidence intervals (CI) were pooled using Stata software.

Results: Six studies generating 281 thoracoscopy and 369 thoracotomy cases were finally included. There was no significant difference in intraoperative blood loss, number of resected lymph nodes, chest drainage time, postoperative complication rate and mortality between two groups. However, thoracoscopic sleeve lobectomy was associated with longer operation time (SMD 0.59, 95% CI: 0.14 to 1.03, P=0.010). And shorter postoperative hospital stays (SMD -0.24, 95% CI: -0.51 to 0.03, P=0.078) were observed in the thoracoscopy group with marginal significance. Furthermore, sleeve lobectomy via thoracoscopy could achieve comparable OS compared to that via thoracotomy (HR 0.69, 95% CI: 0.38 to 1.00; P<0.001). In addition, there were no evident publication bias in all observational outcomes.

Conclusions: Current evidence suggests that thoracoscopic sleeve lobectomy is a safe and efficient surgical procedure for centrally located NSCLC, with comparable perioperative outcomes and equivalent oncological results compared to thoracotomy sleeve lobectomy.

Keywords: Video-assisted thoracoscopic surgery (VATS); non-small cell lung cancer (NSCLC); robotic-assisted thoracoscopic surgery (RATS); sleeve lobectomy; thoracotomy.

Figure 1

Flow diagram of study selection.

Figure 2

Meta-analysis: the operation time for thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.

Figure 3

Meta-analysis: the blood loss for thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.

Figure 4

Meta-analysis: the number of resected lymph nodes for thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.

Figure 5

Meta-analysis: the postoperative hospital stay for thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.

Figure 6

Meta-analysis: the chest drainage time for thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.

Figure 7

Meta-analysis: the postoperative complication rate for thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.

Figure 8

Meta-analysis: the 30-day (A) and 90-day (B) mortality rate for thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.

Figure 9

Meta-analysis: the OS for thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.

Figure 10

The funnel plot and publication bias tests for the OS of thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.

Figure S1

The funnel plot and publication bias tests for operative time of thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.

Figure S2

The funnel plot and publication bias tests for blood loss of thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.

Figure S3

The funnel plot and publication bias tests for number of resected lymph nodes of thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.

Figure S4

The funnel plot and publication bias tests for postoperative hospital stays of thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.

Figure S5

The funnel plot and publication bias tests for chest drainage time of thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.

Figure S6

The funnel plot and publication bias tests for postoperative complication rate of thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.

Figure S7

The funnel plot and publication bias tests for 30-day (A) and 90-day (B) mortality of thoracoscopic and thoracotomy sleeve lobectomy. Note: for propensity matched studies, only cases after matching were included.