It remains unclear whether non-intubated video-assisted thoracoscopic surgery (VATS) is comparable or advantageous compared with conventional intubated VATS. Thus, we systematically assessed the feasibility and safety of non-intubated VATS compared with intubated VATS perioperatively for the treatment of different thoracic diseases. An extensive search of literature databases was conducted. Perioperative outcomes were compared between 2 types of operations. The time trend of the overall results was evaluated through a cumulative meta-analysis. Subgroup analyses of different thoracic diseases and study types were examined. Twenty-seven studies including 2537 patients were included in the analysis. A total of 1283 patients underwent non-intubated VATS; intubated VATS was performed on the other 1254 patients. Overall, the non-intubated VATS group had fewer postoperative overall complications [odds ratios (OR) 0.505; P < 0.001]; shorter postoperative fasting times [standardized mean difference (SMD) −2.653; P < 0.001]; shorter hospital stays (SMD −0.581; P < 0.001); shorter operative times (SMD −0.174; P = 0.041); shorter anaesthesia times (SMD −0.710; P < 0.001) and a lower mortality rate (OR 0.123; P = 0.020). Non-intubated VATS may be a safe and feasible alternative to intubated VATS and provide a more rapid postoperative rehabilitation time than conventional intubated VATS.
KEYWORDS 2 lung cancer, spread through air spaces, lobectomy, prognosis, meta-analysis 3 Abstract Background: Previous studies have confirmed the poor prognostic value of spread through air spaces (STAS) in patients undergoing limited resection for lung cancer. Nevertheless, its prognostic value remains controversial in patients undergoing lobectomy. Consequently, we aim to systematically and comprehensively evaluate the prognosis of patients with STAS undergoing lobectomy for lung cancer. Methods: An extensive search of literature databases was conducted. Recurrence-free survival (RFS) and overall survival (OS) were compared between patients with or without STAS undergoing lobectomy. In addition, results of the limited resection were also evaluated and presented. Results: 5 studies with 1531 patients reported the outcomes of lobectomy and 4 studies including 505 patients evaluated the survival of limited resection. In patients undergoing lobectomy, STAS was associated with significantly worse survival than non-STAS, including both RFS (HR=1.700; 95% CI: 1.265-2.283; P 0.001; P for heterogeneity=0.637; I2=0.0%) and OS (HR=2.620; 95% CI:1.138-6.031; P=0.024; P for heterogeneity=0.128; I2=51.4%). STAS was also correlated with shorter RFS (HR=3.434, 95%CI 2.173 to 5.428; P 0.001; P for heterogeneity=0.828, I2=0.0%) and OS (HR=3.494, 95%CI 2.128 to 5.736; P 0.001; P for heterogeneity=0.501, I2=0.0%) in limited resection.Conclusions: STAS is a poor prognostic indicator in patients undergoing lobectomy for lung cancer.
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