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. 2023 May 31:10:1152421.
doi: 10.3389/fmed.2023.1152421. eCollection 2023.

Minimally invasive surgery vs. open thoracotomy for non-small-cell lung cancer with N2 disease: a systematic review and meta-analysis

Songlin Liu #  1   2 , Shaopeng Li #  2   3 , Yong Tang  1 , Rixin Chen  1 , Guibin Qiao  1
Affiliations

Minimally invasive surgery vs. open thoracotomy for non-small-cell lung cancer with N2 disease: a systematic review and meta-analysis

Songlin Liu et al. Front Med (Lausanne). .

Abstract

Background: This meta-analysis aimed to investigate the effectiveness and safety of minimally invasive surgery [MIS, including robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS)] and open thoracotomy (OT) for non-small cell lung cancer (NSCLC) patients with N2 disease.

Methods: We searched online databases and studies from the creation of the database to August 2022, comparing the MIS group to the OT group for NSCLC with N2 disease. Study endpoints included intraoperative outcomes [e.g., conversion, estimated blood loss (EBL), surgery time (ST), total lymph nodes (TLN), and R0 resection], postoperative outcomes [e.g., length of stay (LOS) and complication], and survival outcomes [e.g., 30-day mortality, overall survival (OS), and disease-free survival (DFS)]. We estimated outcomes using random effects meta-analysis to account for studies with high heterogeneity (I2 > 50 or p < 0.05). Otherwise, we used a fixed-effect model. We calculated odds ratios (ORs) for binary outcomes and standard mean differences (SMDs) for continuous outcomes. Treatment effects on OS and DFS were described by hazard ratio (HR).

Results: This systematic review and meta-analysis of 15 studies on MIS vs. OT for NSCLC with N2 disease included 8,374 patients. Compared to OT, patients that underwent MIS had less estimated blood loss (EBL) (SMD = - 64.82, p < 0.01), shorter length of stay (LOS) (SMD = -0.15, p < 0.01), higher R0 resection rate (OR = 1.22, p = 0.049), lower 30-day mortality (OR = 0.67, p = 0.03), and longer overall survival (OS) (HR = 0.61, P < 0.01). The results showed no statistically significant differences in surgical time (ST), total lymph nodes (TLN), complications, and disease-free survival (DFS) between the two groups.

Conclusion: Current data suggest that minimally invasive surgery may provide satisfying outcomes, a higher R0 resection rate, and better short-term and long-term survival than open thoracotomy.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022355712.

Keywords: N2 disease; minimally invasive surgery; non-small cell lung cancer; robotic-assisted thoracoscopic surgery; video-assisted thoracoscopic surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Forest plots of open conversion in minimally invasive surgery (MIS).
Figure 3
Figure 3
Forest plots of (A) estimated blood loss, (B) surgical time, (C) length of stay, and (D) total lymph nodes. MIS, minimally invasive surgery; VATS, video-assisted thoracoscopic surgery; CI, confidence interval.
Figure 4
Figure 4
Forest plots of (A) total complications, (B) R0 resections, and (C) 30-day mortality between MIS and OT. MIS, minimally invasive surgery; VATS, video-assisted thoracoscopic surgery; CI, confidence interval.
Figure 5
Figure 5
Forest plots of (A) overall survival, (B) disease-free survival. MIS, minimally invasive surgery; VATS, video-assisted thoracoscopic surgery; CI, confidence interval.
Figure 6
Figure 6
Funnel plots of publication bias test: (A) overall survival and (B) length of stay.
See this image and copyright information in PMC

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