Video-assisted thoracoscopic surgery versus thoracotomy for locally advanced lung cancers: A systematic review and...

Locally advanced lung cancer is considered a relative contraindication for video-assisted thoracoscopic surgery (VATS), and VATS versus conventional open thoracotomy for locally advanced lung cancer has not been studied.

We have searched the Embase, Cochrane Library, PubMed, Medline, and Web of Science for articles on laparoscopic and conventional open thoracotomy. We calculated pooled standard mean difference (SMD), relative risk, and 95% confidence intervals (CIs). The protocol for this review has been registered on PROSPERO (CRD420251240690).

There are 1597 participants including 11 articles. Compared with open thoracotomy, patients who underwent VATS had less operation time (SMD 0.15; CI 0.01-0.29; I2 = 0%, P = .031), blood loss (SMD -0.55; CI -0.69 to 0.42; I2 = 96.8%, P = .000), chest tube duration (SMD -0.17; CI -0.29 to -0.04; I2 = 38.3%, P = .009), and hospital stay (SMD -0.68; CI -0.86 to -0.49; I2 = 43.3%, P = .000). However, there are no difference in ICU days, lymph node resected, lymph node total stations, complications, acute respiratory distress syndrome, atrial arrhythmia, chylothorax, prolonged air leak, pneumonia, and overall recurrence.

Patients who underwent VATS had less operation time, blood loss, chest tube duration, and hospital stay, compared with thoracotomy. There was no difference in complications, lymph node dissection, and overall recurrence between the 2 groups. More high-quality literature is needed to be included in the research in the future.