微创外科手术与开胸手术治疗伴有N2期疾病的非小细胞肺癌：一项系统评价和荟萃分析
Minimally invasive surgery vs. open thoracotomy for non-small-cell lung cancer with N2 disease: a systematic review and meta-analysis.
作者信息
Liu Songlin, Li Shaopeng, Tang Yong, Chen Rixin, Qiao Guibin
机构信息
Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
出版信息
Front Med (Lausanne). 2023 May 31;10:1152421. doi: 10.3389/fmed.2023.1152421. eCollection 2023.
BACKGROUND
This meta-analysis aimed to investigate the effectiveness and safety of minimally invasive surgery [MIS, including robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS)] and open thoracotomy (OT) for non-small cell lung cancer (NSCLC) patients with N2 disease.
METHODS
We searched online databases and studies from the creation of the database to August 2022, comparing the MIS group to the OT group for NSCLC with N2 disease. Study endpoints included intraoperative outcomes [e.g., conversion, estimated blood loss (EBL), surgery time (ST), total lymph nodes (TLN), and R0 resection], postoperative outcomes [e.g., length of stay (LOS) and complication], and survival outcomes [e.g., 30-day mortality, overall survival (OS), and disease-free survival (DFS)]. We estimated outcomes using random effects meta-analysis to account for studies with high heterogeneity ( > 50 or < 0.05). Otherwise, we used a fixed-effect model. We calculated odds ratios (ORs) for binary outcomes and standard mean differences (SMDs) for continuous outcomes. Treatment effects on OS and DFS were described by hazard ratio (HR).
RESULTS
This systematic review and meta-analysis of 15 studies on MIS vs. OT for NSCLC with N2 disease included 8,374 patients. Compared to OT, patients that underwent MIS had less estimated blood loss (EBL) (SMD = - 64.82, < 0.01), shorter length of stay (LOS) (SMD = -0.15, < 0.01), higher R0 resection rate (OR = 1.22, = 0.049), lower 30-day mortality (OR = 0.67, = 0.03), and longer overall survival (OS) (HR = 0.61, < 0.01). The results showed no statistically significant differences in surgical time (ST), total lymph nodes (TLN), complications, and disease-free survival (DFS) between the two groups.
CONCLUSION
Current data suggest that minimally invasive surgery may provide satisfying outcomes, a higher R0 resection rate, and better short-term and long-term survival than open thoracotomy.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022355712.
背景
本荟萃分析旨在研究微创手术[MIS，包括机器人辅助胸腔镜手术（RATS）和电视辅助胸腔镜手术（VATS）]及开胸手术（OT）治疗N2期非小细胞肺癌（NSCLC）患者的有效性和安全性。
方法
我们检索了在线数据库以及从数据库创建至2022年8月的研究，比较MIS组和OT组治疗N2期NSCLC的情况。研究终点包括术中结果[如中转率、估计失血量（EBL）、手术时间（ST）、总淋巴结数（TLN）和R0切除]、术后结果[如住院时间（LOS）和并发症]以及生存结果[如30天死亡率、总生存期（OS）和无病生存期（DFS）]。对于异质性较高（I²>50%或P<0.05）的研究，我们采用随机效应荟萃分析来估计结果。否则，我们使用固定效应模型。我们计算二分类结局的比值比（OR）和连续结局的标准化均数差（SMD）。用风险比（HR）描述对OS和DFS的治疗效果。
结果
这项对15项关于MIS与OT治疗N2期NSCLC的研究进行的系统评价和荟萃分析纳入了8374例患者。与OT相比，接受MIS的患者估计失血量（EBL）更少（SMD=-64.82，P<0.01）、住院时间（LOS）更短（SMD=-0.15，P<0.01）、R0切除率更高（OR=1.22，P=0.049）、30天死亡率更低（OR=0.67，P=0.03）且总生存期（OS）更长（HR=0.61，P<0.01）。结果显示两组在手术时间（ST）、总淋巴结数（TLN）、并发症和无病生存期（DFS）方面无统计学显著差异。
结论
当前数据表明，与开胸手术相比，微创手术可能提供更满意的结果、更高的R0切除率以及更好的短期和长期生存。
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