Wang Hailong, Wang Miao, Xin Ning, Wei Rongqiang, Huang Kenan
Department of Thoracic Surgery, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital affiliated to Soochow University, Suzhou, China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Front Surg. 2022 May 31;9:925003. doi: 10.3389/fsurg.2022.925003. eCollection 2022.
It still remains unclear whether subxiphoid video-assisted thoracoscopic surgery (SVATS) thymectomy is safe and reasonable. This meta-analysis aims at assessing the effectiveness and safety of SVATS for thymoma in comparison with that of intercostal video-assisted thoracoscopic surgery (IVATS) thymectomy.
All the relevant data systematically analyzed in this thesis were retrieved from PubMed, the Cochrane Library, web of science, EMBASE, and ClinicalTrials.gov. The time span for data retrieval was from the date of database establishment to March 2022. The outcome indicators include operation time, intraoperative blood loss, duration of postoperative drainage, postoperative hospital days, visual analogue scale (VAS) score on the day of operation, VAS score on postoperative day 3, and VAS score on postoperative day 7; postoperative complications were analyzed in our meta-analysis.
In 13 studies of this paper, there were 1,198 cases included. Among them, 563 cases were treated by SVATS thymectomy and 635 cases by IVATS thymectomy. There was no significant difference in the operation time [113.38 vs. 119.91 min, 95% confidence interval (CI): -0.70-0.15, = 0.20) and the incidence of intraoperative and postoperative complications (RR = 0.82, 95% CI: 0.58-1.15, = 0.25) between SVATS thymectomy and IVATS thymectomy. However, SVATS thymectomy significantly reduced the amount of intraoperative blood loss (47.68 vs. 66.69 mL, SMD = -0.57, 95% CI: -0.95 to -0.18, = 0.004), postoperative drainage days (2.12 vs. 2.72 days, SMD = -0.46, 95% CI: -0.74 to -0.18, = 0.001), postoperative hospital stays (4.53 vs. 5.91 days, SMD = -0.64, 95% CI: -0.96 to -0.31, = 0.0001), and VAS scores after the operation.
SVATS thymectomy is safe and feasible, and the perioperative effect is better than IVATS thymectomy to a certain extent, which is worthy of popularization and further research. https://www.crd.york.ac.uk/PROSPERO/.
剑突下电视辅助胸腔镜手术（SVATS）胸腺切除术是否安全合理仍不明确。本荟萃分析旨在评估与肋间电视辅助胸腔镜手术（IVATS）胸腺切除术相比，SVATS治疗胸腺瘤的有效性和安全性。
本论文系统分析的所有相关数据均从PubMed、Cochrane图书馆、科学网、EMBASE和ClinicalTrials.gov检索。数据检索的时间跨度为数据库建立之日至2022年3月。结局指标包括手术时间、术中出血量、术后引流时间、术后住院天数、手术当天视觉模拟评分（VAS）、术后第3天VAS评分和术后第7天VAS评分；在我们的荟萃分析中分析了术后并发症。
在本文的13项研究中，共纳入1198例病例。其中，563例行SVATS胸腺切除术，635例行IVATS胸腺切除术。SVATS胸腺切除术与IVATS胸腺切除术在手术时间[113.38对119.91分钟，95%置信区间（CI）：-0.70-0.15，P = 0.20]以及术中和术后并发症发生率（RR = 0.82，95% CI：0.58-1.15，P = 0.25）方面无显著差异。然而，SVATS胸腺切除术显著减少了术中出血量（47.68对66.69毫升，标准化均数差（SMD）=-0.57，95% CI：-0.95至-0.18，P = 0.004）、术后引流天数（2.12对2.72天，SMD=-0.46，95% CI：-0.74至-0.18，P = 0.001）、术后住院时间（4.53对5.91天，SMD=-0.64，95% CI：-0.96至-0.31，P = 0.0001）以及术后VAS评分。
SVATS胸腺切除术安全可行，围手术期效果在一定程度上优于IVATS胸腺切除术，值得推广和进一步研究。https://www.crd.york.ac.uk/PROSPERO/
