Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, UK.
Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece.
Lung. 2021 Feb;199(1):43-53. doi: 10.1007/s00408-020-00411-9. Epub 2021 Jan 2.
We reviewed the available literature on patients with lung cancer undergoing either uniportal (UVATS) or multiport video-assisted thoracoscopic surgery (MVATS).
Original research studies that evaluated perioperative and long-term outcomes of UVATS versus MVATS were identified, from January 1990 to April 2020. The perioperative, along with the oncologic and long-term survival outcomes, were calculated according to either a fixed or a random effect model, appropriately. The Q statistics and I statistic were used to test for heterogeneity among the studies.
Twenty studies were included, incorporating a total of 1,469 patients treated with UVATS and 3,231 treated with MVATS. The incidence of complications was lower in patients treated with UVATS [OR: 0.76 (95% CI 0.62, 0.93); p = 0.008]. The chest tube duration was significantly lower in the UVATS group (WMD: - 0.63 [95% CI - 1.03, - 0.23]; p = 0.002). Length of hospital stay (L.O.S.) was also lower in the UVATS patient group (WMD: - 0.54 [- 0.94, - 0.13]; p = 0.009), along with postoperative pain [WMD: - 0.57 (95% CI - 0.97, - 0.18); p = 0.004]. No significant differences were found regarding the mean operative time (M.O.T.), mean blood loss, the number of resected lymph nodes, the 30-day mortality, along with the survival at 1 and 3 years postoperatively.
The present meta-analysis indicates that UVATS is associated with enhanced outcomes in patients undergoing surgery for lung cancer. Well-designed, randomized studies, comparing UVATS to MVATS, are necessary to further assess their long-term clinical outcomes.
我们回顾了有关接受单端口（UVATS）或多端口电视辅助胸腔镜手术（MVATS）的肺癌患者的现有文献。
从 1990 年 1 月至 2020 年 4 月，确定了评估 UVATS 与 MVATS 围手术期和长期结果的原始研究。根据固定或随机效应模型，分别计算围手术期以及肿瘤学和长期生存结果。使用 Q 统计量和 I 统计量来检验研究之间的异质性。
共纳入 20 项研究，共纳入 1469 例接受 UVATS 治疗的患者和 3231 例接受 MVATS 治疗的患者。接受 UVATS 治疗的患者并发症发生率较低[OR：0.76（95%CI 0.62，0.93）；p=0.008]。UVATS 组的胸腔引流管留置时间明显较短（WMD：-0.63[95%CI -1.03，-0.23]；p=0.002）。UVATS 组患者的住院时间（LOS）也较低（WMD：-0.54[-0.94，-0.13]；p=0.009），术后疼痛也较轻[WMD：-0.57（95%CI -0.97，-0.18）；p=0.004]。两组的手术时间（MOT）、平均出血量、切除的淋巴结数量、30 天死亡率以及术后 1 年和 3 年的生存率均无显著差异。
本荟萃分析表明，UVATS 可改善肺癌患者的手术结果。有必要进行设计良好的随机研究，比较 UVATS 与 MVATS，以进一步评估它们的长期临床结果。
