Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Surg Res. 2021 Jul;263:274-284. doi: 10.1016/j.jss.2020.10.020. Epub 2020 Dec 9.
The magnitude of association and quality of evidence comparing surgical approaches for lung cancer resection has not been analyzed. This has resulted in conflicting information regarding the relative superiority of the different approaches and disparate opinions on the optimal surgical treatment. We reviewed and systematically analyzed all published data comparing near- (30-d) and long-term mortality for minimally invasive to open surgical approaches for lung cancer.
Comprehensive search of EMBASE, MEDLINE, and the Cochrane Library, from January 2009 to August 2019, was performed to identify the studies and those that passed bias assessment were included in the analysis utilizing propensity score matching techniques. Meta-analysis was performed using random-effects and fixed-effects models. Risk of bias was assessed via the Newcastle-Ottawa Scale and the ROBINS-I tool. The study was registered in PROSPERO (CRD42020150923) prior to analysis.
Overall, 1382 publications were identified but 19 studies were included encompassing 47,054 patients after matching. Minimally invasive techniques were found to be superior with respect to near-term mortality in early and advanced-stage lung cancer (risk ratio 0.45, 95% confidence interval [CI] 0.21-0.95, I = 0%) as well as for elderly patients (odds ratio 0.45, 95% CI 0.31-0.65, I = 30%), but did not demonstrate benefit for high-risk patients (odds ratio 0.74, 95% CI 0.06-8.73, I = 78%). However, no difference was found in long-term survival.
We performed the first systematic review and meta-analysis to compare surgical approaches for lung cancer which indicated that minimally invasive techniques may be superior to thoracotomy in near-term mortality, but there is no difference in long-term outcomes.
对于肺癌切除术的不同手术方法的关联程度和证据质量尚未进行分析。这导致了关于不同方法的相对优势的相互矛盾的信息，以及对最佳手术治疗的不同看法。我们回顾并系统地分析了所有比较微创与开放手术方法治疗肺癌的近（30 天）期和长期死亡率的已发表数据。
从 2009 年 1 月到 2019 年 8 月，我们对 EMBASE、MEDLINE 和 Cochrane 图书馆进行了全面检索，以确定研究，并对通过偏倚评估的研究进行了分析，使用倾向评分匹配技术。使用随机效应和固定效应模型进行荟萃分析。使用纽卡斯尔-渥太华量表和 ROBINS-I 工具评估风险偏倚。在分析之前，该研究在 PROSPERO（CRD42020150923）中进行了注册。
总体而言，共确定了 1382 篇文献，但在匹配后，仅纳入了 19 项研究，共包含 47054 例患者。微创技术在早期和晚期肺癌（风险比 0.45，95%置信区间 [CI] 0.21-0.95，I = 0%）以及老年患者（优势比 0.45，95%CI 0.31-0.65，I = 30%）中近中期死亡率方面表现出优势，但在高危患者中未显示获益（优势比 0.74，95%CI 0.06-8.73，I = 78%）。然而，长期生存率没有差异。
我们进行了首次系统评价和荟萃分析，以比较肺癌的手术方法，结果表明微创技术在近期死亡率方面可能优于开胸手术，但在长期结果方面没有差异。
