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Video-Assisted Thoracoscopic Sleeve Lobectomy for Centrally Located Non-small Cell Lung Cancer: A Meta-analysis

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Abstract

Background

Whether video-assisted thoracoscopic surgery (VATS) sleeve lobectomy could be an alternative to traditional thoracotomy sleeve lobectomy in treating centrally located non-small cell lung cancer (NSCLC) remains unclear. Therefore, we conducted the first meta-analysis to compare the effects of VATS sleeve lobectomy with thoracotomy sleeve lobectomy.

Methods

We systematically searched relevant studies from Pubmed, Embase, and Web of Science on May 12, 2020. Data for analysis included short-term outcomes (blood loss, lymph node dissected, operation time, hospital stay, complications) and long-term outcomes (3-year overall survival (OS) and progression-free survival (PFS) rates). We calculated the weighted mean differences (WMDs) for continuous data and risk ratio (RR) for pooling categorical data.

Results

We finally included 5 retrospective cohort study consisting of 436 patients. VATS sleeve lobectomy yielded significantly less blood loss (WMD =  −37.83; 95% confidence intervals (CIs) = [−58.56, −17.11]; P < 0.001) than thoracotomy sleeve lobectomy and comparable total number of dissected lymph node to thoracotomy sleeve lobectomy (WMD =  − 0.07; 95%CI = [−1.14, 0.99]; P = 0.89). However, VATS sleeve lobectomy consumed significantly more operation time than thoracotomy sleeve lobectomy (WMD = 49.00; 95%CI = [14.67, 83.34]; P = 0.005). VATS sleeve lobectomy yielded significantly less postoperative hospital stay time than thoracotomy sleeve lobectomy (WMD =   −1.68; 95%CI = [−2.98, −0.39]; P = 0.011) and comparable postoperative complication rate to thoracotomy sleeve lobectomy (RR = 0.84; 95%CI = [0.49, 1.44]; P = 0.52). Moreover, VATS sleeve lobectomy yielded comparable 3-year OS (RR = 1.08; 95%CI = [0.95, 1.22]; P = 0.23) and PFS (RR = 1.15; 95%CI = [0.96, 1.37]; P = 0.13) rates to thoracotomy sleeve lobectomy. No significant heterogeneities were observed.

Conclusions

VATS sleeve lobectomy yielded less surgical trauma than thoracotomy sleeve lobectomy and improved postoperative recovery without compromising oncological prognosis. Even though VATS sleeve lobectomy may consume more operation time, it could be recommended as an alternative to thoracotomy sleeve lobectomy for treating centrally located NSCLC in carefully selected cases.

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Abbreviations

VATS:

Video-assisted thoracoscopic surgery

NSCLC:

Non-small cell lung cancer

OS:

Overall survival

PFS:

Progression-free survival

WMDS:

Weighted mean differences

RR:

Risk ratio

CI:

Confidence intervals

RCT:

Randomized controlled trial

SD:

Standard deviation

PSM:

Propensity score matched

NOS:

Newcastle–Ottawa Scale

References

  1. F Bray J Ferlay I Soerjomataram 2018 Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries CA Cancer J Clin 68 394 424

    Article  Google Scholar 

  2. RL Siegel KD Miller A Jemal 2019 Cancer statistics, 2019 CA Cancer J Clin 69 7 34

    Article  Google Scholar 

  3. JA Howington MG Blum AC Chang 2013 Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines Chest 143 e278S e313S

    Article  CAS  Google Scholar 

  4. DS Ettinger DE Wood DL Aisner 2017 Non-small cell lung cancer version 5.2017 NCCN clinical practice guidelines in oncology J Natl Compr Cancer Netw 15 504 535

    Article  Google Scholar 

  5. RF Casal MR Vial R Miller 2017 What exactly is a centrally located lung tumor? Results of an online survey Annals Am Thorac Soc 14 118 123

    Article  Google Scholar 

  6. L Santambrogio U Cioffi M Simone De 2002 Video-assisted sleeve lobectomy for mucoepidermoid carcinoma of the left lower lobar bronchus: a case report Chest 121 635 636

    Article  Google Scholar 

  7. S Zhou G Pei Y Han 2015 Sleeve lobectomy by video-assisted thoracic surgery versus thoracotomy for non-small cell lung cancer J Cardiothorac Surg 10 116

    Article  Google Scholar 

  8. L Wu H Wang H Cai 2019 Comparison of double sleeve lobectomy by uniportal Video-assisted thoracic surgery and thoracotomy for NSCLC treatment Cancer Manag Res 11 10167 10174

    Article  Google Scholar 

  9. HJ Gao ZH Jiang L Gong 2019 Video-assisted versus thoracotomy sleeve lobectomy for lung cancer: a propensity matched analysis Annals Thorac Surg 108 4 1072 1079

    Article  Google Scholar 

  10. T Qiu Y Zhao Y Xuan 2019 Robotic sleeve lobectomy for centrally located non-small cell lung cancer: a propensity score-weighted comparison with thoracoscopic and open surgery J Thorac Cardiovasc Surg 160 3 838 846

    Article  Google Scholar 

  11. D Xie J Deng D Gonzalez-Rivas 2020 Comparison of video-assisted thoracoscopic surgery with thoracotomy in bronchial sleeve lobectomy for centrally located non-small cell lung cancer J Thorac Cardiovasc Surg https://doi.org/10.1016/j.jtcvs.2020.01.105

    Article  PubMed  Google Scholar 

  12. D Moher A Liberati J Tetzlaff 2009 Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement PLoS medicine 6 e1000097

    Article  Google Scholar 

  13. HY Deng ZJ Zhu YC Wang 2016 Non-intubated video-assisted thoracoscopic surgery under loco-regional anaesthesia for thoracic surgery: a meta-analysis Interact Cardiovasc Thorac Surg 23 31 40

    Article  Google Scholar 

  14. HY Deng YC Wang PZ Ni 2017 Radiotherapy, lobectomy or sublobar resection? A meta-analysis of the choices for treating stage I non-small-cell lung cancer Eur J Cardio Thorac Surg 51 203 210

    Google Scholar 

  15. GH Guyatt AD Oxman GE Vist 2008 GRADE: an emerging consensus on rating quality of evidence and strength of recommendations BMJ (Clinical research ed.) 336 924 926

    Article  Google Scholar 

  16. Lewis RJ, Caccavale RJ, Sisler GE, et al. () Video-assisted thoracic surgical resection of malignant lung tumors The Journal of thoracic and cardiovascular surgery 1992: 104; 1679–1685; discussion 1685–1677

  17. NR Villamizar MD Darrabie WR Burfeind 2009 Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy J Thorac Cardiovasc Surg 138 419 425

    Article  Google Scholar 

  18. WJ Scott MS Allen G Darling 2010 Video-assisted thoracic surgery versus open lobectomy for lung cancer a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial The Journal of thoracic and cardiovascular surgery 139 976 981 Discussion 981-973

    Article  Google Scholar 

  19. RP Petersen D Pham WR Burfeind 2007 Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer Annals Thorac Surg 83 1245 1249 discussion 1250

    Article  Google Scholar 

  20. PC Lee A Nasar JL Port 2013 Long-term survival after lobectomy for non-small cell lung cancer by video-assisted thoracic surgery versus thoracotomy Annals Thorac Surgery 96 951 960

    Article  Google Scholar 

  21. ES Kim YT Kim CH Kang 2016 Prevalence of and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early-stage COPD Int J Chronic Obstr Pulm Dis 11 1317 1326

    Article  Google Scholar 

  22. H-Y Deng 2020 Sleeve lobectomy for centrally located non-small cell lung cancer: Does incision size really matter? Ann Thorac Surg 109 612 612

    Article  Google Scholar 

  23. R Caso TJ Watson PG Khaitan 2018 Outcomes of minimally invasive sleeve resection J Thorac Dis 10 6653 6659

    Article  Google Scholar 

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Acknowledgements

We sincerely thank all the authors of the original articles.

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Authors and Affiliations

  1. Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, People’s Republic of China

    Han-Yu Deng, Xiao-Ming Qiu, Da-Xing Zhu, Xiaojun Tang & Qinghua Zhou

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  1. Han-Yu Deng
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  2. Xiao-Ming Qiu
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  3. Da-Xing Zhu
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  4. Xiaojun Tang
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  5. Qinghua Zhou
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Contributions

HYD collected data and drafted the manuscript. HYD and XMQ analyzed the data under the guidance of DXZ. XT and QZ designed the study and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiaojun Tang.

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The authors declare that they have no conflict of interest.

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Supplementary file1 (DOCX 39 kb)

Sensitivity analysis for (a): postoperative complication rate, and (b): 3-year overall survival rate. (tif 679 kb)

268_2020_5877_MOESM3_ESM.tif

Funnel plot of the included studies based on the analysis of 3-year overall survival rate. Begg’s test: P=0.33; Egger’s test: P=0.13. (tif 197 kb)

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Deng, HY., Qiu, XM., Zhu, DX. et al. Video-Assisted Thoracoscopic Sleeve Lobectomy for Centrally Located Non-small Cell Lung Cancer: A Meta-analysis. World J Surg 45, 897–906 (2021). https://doi.org/10.1007/s00268-020-05877-5

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  • DOI: https://doi.org/10.1007/s00268-020-05877-5

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