PCN45 - Postoperative Complication Rate of three Different Surgeries in the Treatment of Lung Cancer in Chinese Patients: Literature Review and Single-Arm Meta-Analysis

Abstract

Video-assisted thoracic surgery (VATS), hybrid VATS (hVATS) and thoracotomy (TH) are three major approaches for lung cancer surgery in China, involving an increasing order of invasiveness and trauma. The objective of this meta-analysis is to assess the relative clinical evidence of postoperative complications (POC) among the three surgical approaches. A thorough search of major electronic databases was conducted to identify studies through September 2017 reporting POC in Chinese population undergoing lung cancer surgery. Random-effects meta-analysis was conducted using non-comparative binary data in RevMan software to estimate mean (95% CI) for POC rate. 58 studies, with a total of 7,813 patients (4,403 VATS, 531 hVATS, and 2,879 TH), were included. The overall POC rate was 14.5% (12.3%-16.7%). TH had the highest POC rate (21.9%, 18.0%-25.9%), followed by hVATS (11.5%, 6.5%-18.7%), and VATS (10.7%, 9.1%-13.8%). Overall among the three approaches, major POCs were air leak (3.8%, 2.9%-5.7%), arrhythmia (3.8%, 2.9%-5.7%), pneumonia (3.8%, 2.9%-5.7%), pneumothorax (2.9%, 2.0%-5.7%) and surgical site infection (SSI) (2.9%, 2.0%-3.8%). However, top POCs varied by approach, as follows: VATS - arrhythmia (5.7%, 4.8%-6.5%), air leaks (3.8%, 2.0%-5.7%), atelectasis (3.8%, 2.9%-5.7%), pleural effusion (3.8%, 1.0%-9.1%), and pneumonia (2.9%, 2.0%-4.8%); hVATS - pleural effusion (5.7%, 2.0%-16.7%), pneumonia (5.7%, 3.8%-9.9%), air leaks (3.8%, 2.0%-9.1%), SSI (3.8%, 2.0%-9.1%), and arrhythmia (3.8%, 2.0%-7.4%); and TH - air leak (5.7%, 2.9%-9.1%), pneumonia (5.7%, 3.8%-8.3%), arrhythmia (5.7%, 3.8%-8.3%), pneumothorax (5.7%, 2.9%-9.9%), and SSI (4.8%,3.8%-6.5%). Postoperative bleeding was the lowest in VATS (1.0%, 1.0%-2.9%), followed by hVATS 2.9% (0%-1.9%), and the highest in TH (3.8%, 2.0%-7.4%). Postoperative complications in surgical treatment of lung cancer in China is still very high. This analysis suggests that less traumatic procedures are associated with reduced postoperative complication rates, and may be considered for broader adoption.