Video-assisted thoracoscopic surgery versus open lobectomy for stage I lung cancer: A meta-analysis of long-term outcomes

Abstract

Abstract. The present study aimed to evaluate the evidence comparing video-assisted thoracoscopic surgery (VATS) and open lobectomy for the treatment of stage I lung cancer using meta-analytical techniques. A literature search was undertaken until July 2011 to identify comparative studies evaluating survival rates, recurrence rates and complications. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated with either the fixed-or random-effects model. These studies included a total of 1, IntroductionLung cancer is the most common malignant tumor in the world. With the improvement in diagnostic technology, more and more stage I lung cancer is identified. Video-assisted thoracoscopic surgery (VATS) was first reported by Levi et al in 1990 (1). The inital clinical reports on video-assisted thoracoscopic surgery lobe ctomy, published from 1993 onward, were either preliminary or involved a small number of patients, which indicated the feasibility and safety of VATS lobectomy (2-6). Since then, VATS has become an attractive surgical procedure for benign diseases, due to its low invasiveness (7,8). As the experience with VATS for benign diseases increased, VATS was gradually adopted for the treatment of lung cancer. Thereafter, VATS lobectomy for elderly patients and series involving a larger number of patients were reported (9-14). VATS lobectomy is now accepted, if not universally, at least as an alternative surgical option for early-stage lung cancer.The advantages of VATS lobectomy, which include less pain and better pulmonary function in the early postoperative period, have been previously reported. However, there are various controversies regarding the prognosis of VATS vs. open lobectomy for stage I lung cancer. Immune system function in the early postoperative period was found to be better preserved in patients who underwent VATS lobectomy. Curability after VATS lobectomy was also reported to be similar to the generally accepted curability rate after open lobectomy. Several investigators reported that the survival rate after VATS lobectomy was similar to that after open lobectomy. Sawada et al (15), Sugiura et al (16), Tashima et al (17) and Flores et al (18) reported that there was no statistically significant difference in survival between the VATS and open lobectomy in early-stage lung cancer. However, this meta-analysis showed that VATS had significantly better survival rates in terms of overall survival at 5 years. Materials and methodsStudy selection. Electronic searches were performed of the MEDLINE, Cochrane Controlled Trial Register (CENTRAL) and EMBASE databases until July 2011. The following Mesh search headings were used: (VATS, video-assisted thoracoscopic or video-assisted thoracoscopic surgery), (open or conventional or standard lobectomy), (lung cancer or lung carcinoma), (randomized controlled trials) and (comparative study) in English (Fig. 1).Data extraction and quality assessment. Data were extracted by three independent observers using standardized forms. The rec...

Influence of video-assisted thoracoscopic lobectomy on immunological functions in non-small cell lung cancer patients

“…Rueth et al [21] compared the two procedures and showed that VATS lobectomy is less algetic than TOS, less immunosuppressive, and elicits milder inflammatory responses compared to TOS. Similar to our results, Li et al [22] also showed a significantly reduced systemic recurrence rate and post-surgery complications in VATS compared to TOS.…”

Post-thoracotomy pain and long-term survival associated with video-assisted thoracic surgery lobectomy methods for clinical T1N0 lung cancer: a patient-oriented, prospective cohort study

“…This review produced 39 studies involving 3256 thoracotomies and 3114 VATS patients [3]. Other systematic reviews and metaanalyses that similarly show the superiority of VATS can be found in the literature [4,5]. However, the methodology of the VATS groups was very heterogeneous in those studies: many types of VATS approaches were used because the technical approach to VATS lobectomy for lung cancer varies depending on each surgical facility.…”

First Italian Consensus Conference on VATS Lobectomy for NSCLC

“…There was no significant 3-year disease-free survival difference between the VATS and open group (85.3% vs 81.8%); similarly, the overall 3-year survival was comparable (96.6% vs 97.4%). Li and colleagues published a meta-analysis of long-term outcome after VATS or open lobectomy for stage I NSCLC in 2012 (11). Out of 213 articles, the authors selected 9 studies that included 1,362 patients; of the selected studies, only 1 was a randomized controlled trial.…”