Is thoracoscopy superior to thoracotomy in the treatment of congenital lung malformations? An updated meta-analysis

Abstract

Background: A meta-analysis was performed for a comparison of outcomes between video-assisted thoracoscopic surgery (VATS) and thoracotomy for congenital lung malformations (CLM).

Methods: Electronic databases, including PubMed, Scopus, Embase, and the Cochrane Library were searched systematically for literature aimed mainly at reporting the therapeutic effects for CLM administrated by VATS and thoracotomy.

Results: A total of 40 studies meeting the inclusion criteria were included, involving 2896 subjects. VATS was associated with fewer complications [odds ratio (OR) 0.54; 95% confidence interval (CI), 0.42-0.69], less use of epidural anesthesia (OR, 0.08; 95% CI, 0.03-0.23), shorter length of hospital stay [standard mean difference (SMD) -0.98; 95% CI, -1.4 to -0.55] and chest drainage (SMD, -0.43; 95% CI, -0.7 to -0.17), as compared with thoracotomy. However, thoracotomy showed superiority in reduced operative time (SMD, 0.44; 95% CI, 0.04-0.84). Pearson analysis (Pearson r = 0.85, 95% CI, 0.28 to 0.98, p = 0.01) and linear regression (R square 0.73) confirmed a positive correlation between percentage of symptomatic cases and conversion in patients using VATS.

Conclusion: VATS is associated with fewer complications, less use of epidural anesthesia, shorter length of stay and length of chest drainage, but longer operative time, as compared with thoracotomy. Symptomatic patients with CLM using VATS may be prone to conversion to thoracotomy.The reviews of this paper are available via the supplemental material section.

Keywords: children; congenital lung malformation; thoracoscopy; thoracotomy.

Figure 1.

Flowchart of process for literature screening for this meta-analysis according to PRISMA guidelines. CLM, congenital lung malformations; PRISMA, preferred reporting items for systematic reviews and meta-analyses.

Figure 2.

Forest plots of complications and use of epidural anesthesia. Forest plot of OR of (A) post-operative complications and (B) use of epidural anesthesia. CI, confidence interval; M–H, Mantel–Haenszel; OR, odds ratio; VATS, video-assisted thoracoscopic surgery.

Figure 3.

Forest plot of operative time (min) and LOS (days). (A) Forest plot of SMD of operative time; (B) forest plot of SMD of LOS. CI, confidence interval; LOS, length of stay; OR, odds ratio; SD, standard deviation; SMD, standard mean difference; VATS, video-assisted thoracoscopic surgery.

Figure 4.

Forest plot of length of chest drainage (days) and publication bias analysis by funnel plot. (A) Forest plot of SMD of length of chest drainage; (B) publication bias analysis by funnel plot. CI, confidence interval; OR, odds ratio; SD, standard deviation; SE, standard error; SMD, standard mean difference; VATS, video-assisted thoracoscopic surgery.

Figure 5.

Pearson analysis and linear regression. (A) Correlation between percentage of symptomatic cases and conversion using the VATS; (B) correlation between percentage of symptomatic cases and lobectomy. VATS, video-assisted thoracoscopic surgery.