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

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.