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Meta-Analysis
. 2021 May 8;59(5):940-950.
doi: 10.1093/ejcts/ezaa437.

Minimally invasive surgery versus thoracotomy for resectable stage II and III non-small-cell lung cancers: a systematic review and meta-analysis

Haifeng Shen  1 , Xin Wang  1 , Yuntao Nie  1 , Kai Zhang  1 , Zihan Wei  1 , Fan Yang  1 , Jun Wang  1 , Kezhong Chen  1
Affiliations
Meta-Analysis

Minimally invasive surgery versus thoracotomy for resectable stage II and III non-small-cell lung cancers: a systematic review and meta-analysis

Haifeng Shen et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: The study aimed to compare the long-term oncological efficacy and perioperative outcomes of patients with locally advanced non-small-cell lung cancers who underwent minimally invasive surgery (MIS) or thoracotomy.

Methods: Cochrane Library, PubMed and EMBASE databases, ClinicalTrials.gov and reference lists were searched for relevant studies. Two reviewers independently assessed the quality of the studies. Recurrence-free survival (RFS) and overall survival (OS) and perioperative outcomes were synthesized. Random-effects models were used to summarize hazard ratios (HRs), relative risks and standardized mean differences (SMDs) with 95% confidence intervals (CIs).

Results: Twenty-three retrospective cohort studies were reviewed with a total of 3281 patients, of whom 1376 (41.9%) received MIS and 1905 (58.1%) received thoracotomy. Meta-analysis showed no significant differences in both RFS (HR, 1.02; 95% CI, 0.89-1.17; P = 0.78) and OS (HR, 0.91; 95% CI, 0.80-1.03; P = 0.15) between MIS versus thoracotomy approaches. Similar results were observed in propensity score matched studies (RFS, HR, 0.94; 95% CI, 0.73-1.20; P = 0.62; OS, HR, 0.96; 95% CI, 0.72-1.30; P = 0.81). No significant difference was found in lymph node clearance and margin positivity. As for perioperative outcomes, MIS was associated with a significant reduction in postoperative complications (relative risk, 0.83; P = 0.01), intraoperative blood loss (standardized mean difference, -0.68; P = 0.007), chest tube drainage (standardized mean difference, -0.38; P = 0.03) and length of hospital stay (standardized mean difference, -0.79; P = 0.002) when compared with thoracotomy.

Conclusions: The use of MIS for resectable stage II and III non-small-cell lung cancers is an eligible alternative to conventional thoracotomy without compromising the long-term survival and short-term outcomes.

Keywords: Minimally invasive surgery; Non-small-cell lung cancers; Perioperative outcomes; Survival; Thoracotomy.

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  • Reply to Zhang et al.
    Shen H, Wang X, Chen K. Shen H, et al. Eur J Cardiothorac Surg. 2022 Nov 3;62(6):ezac527. doi: 10.1093/ejcts/ezac527. Eur J Cardiothorac Surg. 2022. PMID: 36321964 No abstract available.