一项关于微创外科手术与开胸手术治疗中央型非小细胞肺癌的荟萃分析。

A meta-analysis of minimally invasive surgery versus thoracotomy for centrally located non-small cell lung cancer.

作者信息

Li Zhengjun, Xia Mozhu, Liu Chang, Wang Tao, Ren Yi, Liu Yongyu

机构信息

Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China.

Department of Operation Room, First Affiliated Hospital, China Medical University, Shenyang, China.

出版信息

J Thorac Dis. 2021 Jan;13(1):252-261. doi: 10.21037/jtd-20-3273.

DOI:10.21037/jtd-20-3273

PMID:33569205

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7867798/

Abstract

BACKGROUND

Surgery is established as the most effective treatment for central lung cancer. Minimally invasive surgery (MIS) is gaining popularity. The decision of whether surgical treatment of central lung cancer should be minimally invasive or a conventional thoracotomy is a critical decision for the thoracic surgeon. However, whether MIS is more advantageous than other surgical treatments for central lung cancer. This study aimed to compare the short- and long-term results of MIS and conventional thoracotomy in patients with central lung cancer.

METHODS

This meta-analysis was conducted using the PubMed, Embase, Wiley Online Library, Google Scholar, Wanfang, and China National Knowledge Infrastructure databases. Searches for relevant studies were conducted in strict accordance with research protocols detailed in the Cochrane handbook. The primary endpoints for comparison between the two surgical methods were perioperative and long-term survival. A 95% confidence interval (CI) for relative risk (RR)/mean difference (MD) was calculated to assess the strength of the correlation.

RESULTS

Nine studies that met the inclusion and exclusion criteria were eventually included in this meta-analysis. These studies involved a total of 5,869 patients [MIS, n =1,140 versus thoracotomy (TH), n =4,729]. The 3- and 5-year disease-free survival (DFS) and the 2-, 3-, and 5-year overall survival (OS) were similar for the MIS and TH groups [OR: 0.86 (95% CI: 0.51-1.43); P=0.55; OR: 1.01 (95% CI: 0.43-2.36); P=0.99, OR: 0.91 (95% CI: 0.78-1.05); P=0.18; OR: 0.90 (95% CI: 0.77-1.06); P=0.22; OR: 0.95 (95% CI: 0.25-1.53); P=0.30]. A subgroup analysis of 8 articles revealed no statistical difference in the pathological type of non-small cell lung cancer (squamous cell carcinoma or adenocarcinoma) between the two groups [OR: 0.99 (95% CI: 0.89-1.09); P =0.81]. However, the MIS group had a lower incidence of blood loss, duration of hospital stay, and fewer complications [MD: -46.25 (95% CI: -85.05 to -7.46); P=0.02; MD: -1.93 (95% CI: -3.15 to -0.7); P=0.002; MD: 0.73 (95% CI: 0.61-0.88); P=0.001].

CONCLUSIONS

MIS was shown to be a more effective option to conventional thoracotomy for the treatment of central lung cancer.

摘要

背景

手术是公认的治疗中央型肺癌最有效的方法。微创手术（MIS）越来越受欢迎。对于胸外科医生来说，决定中央型肺癌的手术治疗应该采用微创手术还是传统开胸手术是一个关键决策。然而，MIS对于中央型肺癌的治疗是否比其他手术方式更具优势。本研究旨在比较MIS与传统开胸手术治疗中央型肺癌患者的短期和长期结果。

方法

本荟萃分析使用了PubMed、Embase、Wiley Online Library、Google Scholar、万方和中国知网数据库。严格按照Cochrane手册中详细的研究方案进行相关研究的检索。两种手术方法比较的主要终点是围手术期和长期生存率。计算相对风险（RR）/平均差（MD）的95%置信区间（CI）以评估相关性强度。

结果

最终9项符合纳入和排除标准的研究被纳入本荟萃分析。这些研究共涉及5869例患者[MIS组，n = 1140；开胸手术（TH）组，n = 4729]。MIS组和TH组的3年和5年无病生存率（DFS）以及2年、3年和5年总生存率（OS）相似[OR：0.86（95%CI：0.51 - 1.43）；P = 0.55；OR：1.01（95%CI：0.43 - 2.36）；P = 0.99，OR：0.91（95%CI：0.78 - 1.05）；P = 0.18；OR：0.90（95%CI：0.77 - 1.06）；P = 0.22；OR：0.95（95%CI：0.25 - 1.53）；P = 0.30]。对8篇文章的亚组分析显示，两组非小细胞肺癌（鳞状细胞癌或腺癌）的病理类型无统计学差异[OR：0.99（95%CI：0.89 - 1.09）；P = 0.81]。然而，MIS组的失血量、住院时间发生率较低，并发症较少[MD： - 46.25（95%CI： - 85.05至 - 7.46）；P = 0.02；MD： - 1.93（95%CI： - 3.15至 - 0.7）；P = 0.002；MD：0.73（95%CI：0.61 - 0.88）；P = 0.001]。