Rusidanmu Aizemaiti, Feng Mingyang, Xu Jinming, Wang Luming, He Cheng, Hu Jian
Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Zhejiang university school of Medicine, Hangzhou 310029, China.
Gland Surg. 2020 Apr;9(2):342-351. doi: 10.21037/gs.2020.03.10.
Over the years, video-assisted thoracic surgery (VATS) thymectomy has progressively replaced trans-sternotomy (TS) in early-stage thymoma (Masaoka stage I and stage II). This meta-analysis aimed to confirm the differences in the efficacies of VATS and TS approaches in early-stage thymoma patients.
A thorough literature search of the following online databases was performed: PubMed, Cochrane Library, Web of Science, and EMBASE. Appropriate search terms, such as "thymoma or thymus neoplasms or Thymic Carcinoma" and "Video-Assisted Thoracic Surgeries or Video-Assisted Thoracoscopic", were used with MeSH search methods. Heterogeneity was assessed first with the Q-test and inconsistency index and sensitivity analysis and subgroup analysis were then used to find the source of heterogeneity.
We retrieved 1,228 articles, 11 articles were selected as the subjects of our research, and 1,222 patients were included in the research (666 VATS cases versus 556 TS cases). VATS caused less blood loss (P=0.02), and required shorter hospital stay (P<0.001), shorter duration of chest tube drainage (P=0.03) than TS. No obvious difference was found in operative time (P=0.14), postoperative recurrence (OR =0.81, 95% CI: 0.35-1.85, P=0.613), postoperative complications (OR =0.60, 95% CI: 0.31-1.16, P=0.129) and R0 resection (OR =0.35, 95% CI: 0.12-1.04, P=0.06), but the trend showed that more patients in the TS group achieved R0 resection.
For early-stage thymoma patients, VATS thymectomy seems to provide many advantages to be considered as a legitimate alternative to TS; however, when performing VATS, surgeons should pay special attention to ensure that R0 resection is achieved.
多年来，电视辅助胸腔镜手术（VATS）胸腺切除术已逐渐取代胸骨切开术（TS）用于早期胸腺瘤（Masaoka I期和II期）。本荟萃分析旨在证实VATS和TS手术方式在早期胸腺瘤患者中的疗效差异。
对以下在线数据库进行全面的文献检索：PubMed、Cochrane图书馆、科学网和EMBASE。使用如“胸腺瘤或胸腺肿瘤或胸腺癌”和“电视辅助胸腔手术或电视辅助胸腔镜检查”等适当的检索词，并采用医学主题词检索方法。首先用Q检验评估异质性，然后用不一致指数、敏感性分析和亚组分析来寻找异质性来源。
我们检索到1228篇文章，选择11篇文章作为研究对象，1222例患者纳入研究（666例VATS病例与556例TS病例）。与TS相比，VATS导致的失血量更少（P = 0.02），住院时间更短（P < 0.001），胸腔引流管留置时间更短（P = 0.03）。手术时间（P = 0.14）、术后复发（OR = 0.81，95%CI：0.35 - 1.85，P = 0.613）、术后并发症（OR = 0.60，95%CI：0.31 - 1.16，P = 0.129）和R0切除（OR = 0.35，95%CI：0.12 - 1.04，P = 0.06）方面未发现明显差异，但趋势显示TS组更多患者实现了R0切除。
对于早期胸腺瘤患者，VATS胸腺切除术似乎具有许多优势，可被视为TS的合理替代方案；然而，在进行VATS时，外科医生应特别注意确保实现R0切除。
