Risk factors for conversion to thoracotomy in patients with lung cancer undergoing video-assisted thoracoscopic surgery: A meta-analysis.

OBJECTIVE

To systematically evaluate the risk factors of conversion to thoracotomy in thoracoscopic surgery (VATS) for lung cancer, and to provide a theoretical basis for the development of personalized surgical plans.

METHODS

CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, Web of Science, and Embase databases were searched by computer from the establishment of the database to March 2024. Relevant studies on the risk factors of conversion to thoracotomy in VATS for lung cancer were searched. Two reviewers independently performed literature screening, data extraction, and quality evaluation, and Stata16.0 software was used for data analysis.

RESULTS

A total of 14 studies were included in this study, with a total sample size of 10605, and a total of 11 risk factors were obtained. Mate analysis showed that, Age ≥ 65 years old [OR(95%CI) = 2.61(1.67,4.09)], male [OR(95%CI) = 1.46(1.19,1.79)], BMI(Body Mass Index) ≥ 25 [OR(95%CI) = 1.79(1.17,2.74)], tuberculosis history [OR(95%CI) = 7.67(4.25,13.83)], enlarged mediastinal lymph nodes [OR(95%CI) = 2.33(1.50,3.06)], lung door swollen lymph nodes [OR(95%CI) = 6.33(2.07,19.32)], pleural adhesion [OR(95%CI) = 2.50(1.93,3.25)], tumor located in the lung Upper lobe [OR(95%CI) = 4.01(2.87,5.60)], sleeve lobectomy [OR(95%CI) = 3.40(1.43,8.08)], diameter of tumor ≥ 3.5cm [OR(95%CI) = 2.13(1.15,3.95)] associated with lung cancer VATS transit thoracotomy.

CONCLUSIONS

Age ≥ 65 years old, male, BMI ≥ 25, tuberculosis history, enlarged mediastinal lymph nodes, lung door swollen lymph nodes, pleural adhesion, tumor located in the lung Upper lobe, sleeve lobectomy, diameter of tumor ≥ 3.5cm are risk factors for conversion to thoracotomy during VATS for lung cancer. Clinicians should pay attention to the above factors before VATS to avoid forced conversion due to the above factors during VATS. Due to the number and limitations of the included studies, the above conclusions need to be validated by additional high-quality studies.

TRAIL REGISTRATION

The protocol was registered into the PROSPERO database under the number CRD42023478648.