Thoracoscopic Lobectomy versus Open Lobectomy in Stage I Non-Small Cell Lung Cancer: A Meta-Analysis

Yi-Xin Cai,Wei Sun,Ni Zhang,Qin-Zi Xu,Xiang-Ning Fu,Sai Yendamuri

doi:10.1371/journal.pone.0082366

Yi-Xin Cai, Wei Sun + Show 4 more

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https://doi.org/10.1371/journal.pone.0082366

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Abstract

The objective of the present meta-analysis was to evaluate the survival, recurrence rate, and complications in patients with stage I non-small cell lung cancer (NSCLC) who received video-assisted thoracoscopic surgery (VATS) or open lobectomy. A literature search was conducted on June 31, 2012 using combinations of the search terms video-assisted thoracic surgery, open thoracotomy, lobectomy, and non-small-cell lung cancer (NSCLC). Inclusion criteria were: 1) Compared video-assisted thoracic surgery (VATS) lobectomy with open lobectomy. 2) Stage I NSCLC. 2) No previous treatment for lung cancer. 4) Outcome data included 5-year survival rate, complication, and recurrence rate. Tests of heterogeneity, sensitivity, and publication bias were performed. A total of 23 studies (21 retrospective and 2 prospective) met the inclusion criteria. VATS was associated with a longer 5-year survival (odds ratio [OR] = 1.622, 95% confidence interval [CI] 1.272 to 2.069; P<0.001), higher local recurrence rate (OR = 2.152, 95% CI 1.349 to 3.434; P = 0.001), similar distant recurrence rate (OR = 0.91, 95% CI 0.33 to 2.48; P = 0.8560), and lower total complication rate (OR = 0.45, 95% CI 0.24 to 0.84; P = 0.013) compared to open lobectomy. VATS was also associated with lower rates arrhythmias, prolonged air leakage, and pneumonia but it did not show any statistical significance. Patients with stage I NSCLC undergoing VATS lobectomy had longer survival and fewer complications than those who received open lobectomy.

Highlights

Since the introduction of thoracoscopic surgery, video-assisted thoracoscopic surgery (VATS) has become a viable option for the treatment of early stage lung cancer
The past decade has seen an increase in the use of VATS for early stage lung cancer, and a recent report based on data from the Society of Thoracic Surgeons database indicated that VATS is used for 32% of all lobectomies in the United States [2]
The results of the analyses indicated that VATS was associated with lower rates of arrhythmias (OR = 0.67, 95% CI 0.44 to 1.01, P = 0.055; Fig. 5B), prolonged air leakage (OR = 0.87, 95% CI 0.64 to 1.18, P = 0.374; Fig. 5C), and pneumonia (OR = 0.68, 95% CI 0.36 to 1.27, P = 0.229; Fig. 5D) than open surgery

Summary

Introduction

Since the introduction of thoracoscopic surgery, video-assisted thoracoscopic surgery (VATS) has become a viable option for the treatment of early stage lung cancer. Since the initial description of VATS in 1992, the number of VATS procedures for early stage lung cancer has steadily increased [1]. The past decade has seen an increase in the use of VATS for early stage lung cancer, and a recent report based on data from the Society of Thoracic Surgeons database indicated that VATS is used for 32% of all lobectomies in the United States [2]. Though the feasibility and the safety of VATS for the treatment of early stage lung cancer has been proven [10,11], there are persisting doubts regarding its oncological value; i.e., the potential compromise of oncological principles during surgery

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