Abstract
VATS-S is a newly introduced surgical technique in the treatment of stage I NSCLC. However, owing to small sample sizes of relevant clinical studies, there is no conclusive evidence of the relative benefit between the outcomes of VATS-S and VATS-L in Chinese patients. This meta-analysis offers the first robust comparative assessment of the safety and clinical outcomes of VATS-S versus VATS-L in Chinese patients with NSCLC-I. A thorough search of major electronic databases was conducted to identify surgical studies on Chinese patients with NSCLC-I till September 2017. Random-effects meta-analysis was used to estimate risk ratios (RRs, 95% CI) and mean differences (MD, 95% CI) for dichotomous and continuous variables, respectively. The main outcomes and measures were operating room time (ORT), intraoperative blood loss (BL), number of lymph nodes resected (LNRN), total volume of chest tube drainage postoperatively (TVCTD), chest tube duration (CTD), length of stay (LOS), post-operative complications (POC), overall cancer recurrence rate (ORR), local cancer recurrence rate (LRR) and distal cancer recurrence rate (DRR). 7 studies, with 762 NSCLC-I patients (229 VATS-S, 533 VATS-L), were included. Patient characteristic baselines were matched between 2 groups, including age (p=0.22), gender (p=0.67) and comorbidity rate (p=0.37). The average follow-up time was 10.2 to 27 months. VATS-S group was associated with a reduction in TVCTD by 224.42 ml (MD:-224.42, 95%CI (-345.06, -103.79), p=0.0003); a reduction of CTD by 0.73 days (-1.42, -0.03; p=0.04); and a reduction of LOS by 0.58 days (-1.04, -0.11; p=0.02). There was no significant difference between the groups in BL, LNRN, POC, ORT, ORR, LRR, and DRR. VATS-S is a less invasive surgical technique which is associated with less chest tube drainage volume, shorter chest tube duration, and shorter length of stay compared to VATS-L in the treatment of Chinese patients with stage I NSCLC.
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