系统评价和荟萃分析：电视辅助胸腔镜手术肺段切除术与肺叶切除术治疗 I 期非小细胞肺癌的比较。

Systematic review and meta-analysis of video-assisted thoracoscopic surgery segmentectomy versus lobectomy for stage I non-small cell lung cancer.

机构信息

Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.

Department of General Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China.

出版信息

World J Surg Oncol. 2020 Feb 27;18(1):44. doi: 10.1186/s12957-020-01814-x.

BACKGROUND

Whether video-assisted thoracoscopic surgery (VATS) segmentectomy and VATS lobectomy provide similar perioperative and oncological outcomes in stage I non-small cell lung cancer (NSCLC) is still controversial.

METHODS

Meta-analysis of 12 studies comparing outcomes after VATS lobectomy and VATS segmentectomy for stage I NSCLC. Data were analyzed by the RevMan 5.3 software.

RESULTS

Disease-free survival (HR 1.19, 95% CI 0.89 to 1.33, P = 0.39), overall survival (HR 1.11, 95% CI 0.89 to 1.38, P = 0.36), postoperative complications (OR = 1.10, 95% CI 0.69 to 1.75, P = 0.7), intraoperative blood loss (MD = 3.87, 95% CI - 10.21 to 17.94, P = 0.59), operative time (MD = 10.89, 95% CI - 13.04 to 34.82, P = 0.37), air leak > 5 days (OR = 1.20, 95% CI 0.66 to 2.17, P = 0.55), and in-hospital mortality (OR = 1.67, 95% CI 0.39 to 7.16, P = 0.49) were comparable between the groups. Postoperative hospital stay (MD = - 0.69, 95% CI - 1.19 to - 0.19, P = 0.007) and number of dissected lymph nodes (MD = - 6.44, 95%CI - 9.49 to - 3.40, P < 0.0001) were significantly lower in VATS segmentectomy patients.

CONCLUSIONS

VATS segmentectomy and VATS lobectomy provide similar oncological and perioperative outcomes for stage I NSCLC patients. This systematic review was registered on PROSPERO and can be accessed at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID = CRD42019133398.

背景

在 I 期非小细胞肺癌（NSCLC）中，电视辅助胸腔镜手术（VATS）肺段切除术和 VATS 肺叶切除术的围手术期和肿瘤学结果是否相似仍存在争议。

方法

对比较 I 期 NSCLC 患者行 VATS 肺叶切除术和 VATS 肺段切除术的 12 项研究进行荟萃分析。使用 RevMan 5.3 软件分析数据。

结果

无病生存率（HR 1.19，95%CI 0.89 至 1.33，P = 0.39）、总生存率（HR 1.11，95%CI 0.89 至 1.38，P = 0.36）、术后并发症（OR = 1.10，95%CI 0.69 至 1.75，P = 0.7）、术中出血量（MD = 3.87，95%CI - 10.21 至 17.94，P = 0.59）、手术时间（MD = 10.89，95%CI - 13.04 至 34.82，P = 0.37）、漏气 > 5 天（OR = 1.20，95%CI 0.66 至 2.17，P = 0.55）和住院死亡率（OR = 1.67，95%CI 0.39 至 7.16，P = 0.49）在两组间无差异。VATS 肺段切除术组患者的术后住院时间（MD = - 0.69，95%CI - 1.19 至 - 0.19，P = 0.007）和清扫的淋巴结数目（MD = - 6.44，95%CI - 9.49 至 - 3.40，P < 0.0001）显著低于 VATS 肺叶切除术组。

结论

VATS 肺段切除术和 VATS 肺叶切除术为 I 期 NSCLC 患者提供了相似的肿瘤学和围手术期结果。本系统评价已在 PROSPERO 上注册，可在 http://www.crd.york.ac.uk/PROSPERO/display_record.php？ID = CRD42019133398 上查阅。