一项比较胸腔镜辅助肺叶切除术和传统开胸肺叶切除术的非匹配和匹配患者的荟萃分析。
A meta-analysis of unmatched and matched patients comparing video-assisted thoracoscopic lobectomy and conventional open lobectomy.
机构信息
The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia; ; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; ; Department of Cardiothoracic Surgery, St. George Hospital, Sydney, NSW, Australia.
出版信息
Ann Cardiothorac Surg. 2012 May;1(1):16-23. doi: 10.3978/j.issn.2225-319X.2012.04.18.
BACKGROUND
Video-assisted thoracic surgery (VATS) for patients with early-stage non-small cell lung cancer (NSCLC) has been established as a safe and feasible alternative to open thoracotomy. This meta-analysis aims to assess the potential difference between unmatched and propensity score-matched cohorts who underwent VATS versus open thoracotomy in the current literature.
METHODS
Three relevant studies with unmatched and propensity score-matched patients were identified from six electronic databases to examine perioperative outcomes after VATS lobectomy versus open thoracotomy for patients with early-stage NSCLC. Endpoints included perioperative mortality and morbidity, individual postoperative complications and duration of hospitalization.
RESULTS
Results indicate that perioperative mortality was significantly lower for VATS compared to open thoracotomy in unmatched patients but no significant difference was detected amongst propensity score-matched patients. Similarly, the incidences of prolonged air leak and sepsis were significantly lower for VATS in the unmatched cohort, but not identified in the propensity score-matched cohort. In both the unmatched and matched groups, patients who underwent VATS were found to have a significantly lower overall perioperative morbidity rate, incidences of pneumonia and atrial arrhythmias, and a shorter duration of hospitalization in comparison to patients who underwent open thoracotomy.
CONCLUSIONS
The present meta-analysis indicates that VATS lobectomy has superior perioperative outcomes compared to open thoracotomy in both matched and unmatched cohorts. However, the extent of the superiority may have been overestimated in the unmatched patients when compared to propensity score-matched patients. Due to the limited number of studies with available data included in the present meta-analysis, these results are only of observational interest and should be interpreted with caution.
背景
对于早期非小细胞肺癌（NSCLC）患者，视频辅助胸腔镜手术（VATS）已被确立为开胸手术的安全可行的替代方法。本荟萃分析旨在评估当前文献中 VATS 与开胸手术相比，在未匹配和倾向评分匹配队列中潜在的差异。
方法
从六个电子数据库中确定了三项涉及未匹配和倾向评分匹配患者的相关研究，以检查 VATS 肺叶切除术与开胸手术治疗早期 NSCLC 患者的围手术期结果。终点包括围手术期死亡率和发病率、术后个别并发症和住院时间。
结果
结果表明，与开胸手术相比，未匹配患者的 VATS 围手术期死亡率显著降低，但倾向评分匹配患者中未发现差异。同样，在未匹配队列中，VATS 术后持续性漏气和脓毒症的发生率明显低于开胸手术，但在倾向评分匹配队列中未发现。在未匹配和匹配组中，与开胸手术相比，接受 VATS 的患者的总体围手术期发病率、肺炎和房性心律失常的发生率以及住院时间明显降低。
结论
本荟萃分析表明，VATS 肺叶切除术在匹配和未匹配队列中均优于开胸手术。然而，与倾向评分匹配患者相比，未匹配患者的优势可能被高估了。由于本荟萃分析中纳入的研究数量有限，且数据可用，因此这些结果仅具有观察性意义，应谨慎解释。
Zotero 插件