Outcomes of Video-Assisted Thoracic Surgery Compared to Open Thoracic Surgery for Pulmonary Hydatid Disease: A...

Pulmonary echinococcosis, or pulmonary hydatid disease, caused by Echinococcus larvae, presents a significant health challenge, particularly in endemic areas. While surgery is the primary treatment for viable cysts, the optimal approach for this remains under debate. There is a lack of comparative evidence comparing traditional open thoracic surgery (OTS) with minimally invasive video-assisted thoracic surgery (VATS). This systematic review and meta-analysis aims to comprehensively compare the efficacy and safety of VATS versus OTS for pulmonary hydatid disease; it will expand on prior research by including patients of all ages and conducting detailed subgroup analyses, sensitivity analyses, and publication bias assessments.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and International Prospective Register of Systematic Reviews registration (CRD420251012764), major databases (PubMed, Scopus, Cochrane Library, Web of Science) were searched up to 5 March 2025, without language or date restrictions. Comparative studies (randomised controlled trials and observational studies) reporting perioperative, postoperative, and recovery outcomes for VATS versus OTS were included. Data were synthesised using random-effects models (calculating mean differences [MDs] or risk ratios with 95% confidence intervals). Heterogeneity (I²), risk of bias (Risk Of Bias In Non-randomised Studies of Interventions) and publication bias (Doi plots, Luis Furuya-Kanamori index) were assessed.

Nine retrospective cohort studies met the inclusion criteria. Compared with OTS, VATS was associated with significantly shorter operation times (MD -38.08 min; p<0.001; I²=92%), lower perioperative blood loss (MD -64.02 mL; p=0.006; I²=98%), reduced postoperative drainage volume (MD -124.46 mL; p=0.003; I²=85%), earlier chest drain removal (MD -2.27 days; p<0.001; I²=92%), and shorter hospital stays (MD -3.68 days; p<0.001; I²=98%). Although VATS showed a trend towards fewer postoperative complications, the difference was not statistically significant (risk ratio 0.72; p=0.13; I²=0%). Significant heterogeneity (I²>85%) was present for most continuous outcomes, and risk of bias assessment indicated high risks in confounding and reporting domains for several studies. Potential publication bias favouring VATS was detected for multiple outcomes.

VATS appears to offer significant perioperative and recovery advantages over OTS for the surgical management of pulmonary hydatid disease. However, these findings must be interpreted with caution. While this review incorporates recently available randomised evidence, the majority of the data remains retrospective, and the pooled results are affected by significant heterogeneity and a high risk of bias in several domains.