Single- <i>versus</i> multiple-port thoracoscopic lobectomy in non-small cell lung cancer: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Hanjie , CHEN Guirong , HUANG Jun ,  HE Jiaxian

Department of Thoracic Surgery, the Wuzhou Red Cross Hospital, Wuzhou, 543002, Guangxi, P.R.China;

Corresponding?author：

HE Jiaxian, Email: 563791044@qq.com

Keywords：

Video-assisted thoracoscopic surgery; non-small cell lung cancer; single-port; multiple-port; lobectomy; meta-analysis

DOI：

10.7507/1007-4848.201810042

Video：

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Objective To systematically review the efficacy and safety of single-port video-assisted thoracoscopic surgery (VATS) vs. multiple-port VATS in lobectomy for non-small cell lung cancer (NSCLC).Methods The PubMed, EMbase, the Cochrane Library, CBM, CNKI, Wanfang, VIP and Web of Science were searched to collect clinical studies about single- vs. multiple-port VATS for patients with NSCLC from inception to August 2018. The literatures were screened, data were extracted and the risk of bias of included studies was assessed independently by two reviewers. The meta-analysis with the collected data was performed by using RevMan 5.3 software.Results Eleven studies (4 randomized controlled trials, 1 prospective cohort study and 6 retrospective cohort studies), including 1 574 patients. Among them, 779 patients were in the single-port group, and 795 in the multiple-port group. The results of meta-analysis showed that there was no significant difference between the two groups in the operation time (MD=3.60, 95%CI –8.59 to 15.79, P=0.56), the conversion rate (OR=1.06, 95%CI 0.54 to 2.06, P=0.87), the incidence of postoperative complications (OR=0.76, 95%CI 0.53 to 1.10, P=0.15), postoperative hospitalization time (MD=0.74, 95%CI –1.60 to 0.12, P=0.09), chest tube placement time (MD=0.63, 95%CI –1.28 to 0.02, P=0.06) or harvested lymph nodes (MD=–0.11, 95%CI –0.46 to 0.24, P=0.54). The intraoperative blood loss (MD=–17.12, 95%CI –31.16 to –3.08, P=0.02) was less in the single-port group than that in the multiple-port group. The visual analogue score (VAS) on postoperative first day (MD=–1.30, 95%CI –1.85 to –0.75, P<0.000 01) and on postoperative third day (MD=–0.82, 95%CI –1.00 to –0.65, P<0.000 01) were lower in the single-port group than those in the multiple-port group.Conclusion The meta-analysis indicates that the efficacy of single-port VATS for NSCLC is equivalent to multiple-port VATS. However the intraoperative blood loss, the VAS scores on postoperative first and third days in the single-port group are better.

Citation： XU Hanjie, CHEN Guirong, HUANG Jun, HE Jiaxian. Single- versus multiple-port thoracoscopic lobectomy in non-small cell lung cancer: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(8): 789-794. doi: 10.7507/1007-4848.201810042 Copy

1.	Rafiemanesh H, Mehtarpour M, Khani F, et al. Epidemiology, incidence and mortality of lung cancer and their relationship with the development index in the world. J Thorac Dis, 2016, 8(6): 1094-1102.
2.	Hartwig MG, D'Amico TA. Thoracoscopic lobectomy: the gold standard for early-stage lung cancer? Ann Thorac Surg, 2010, 89(6): S2098-S2101.
3.	王繼振, 劉公哲, 李大宏. 單孔全胸腔鏡下肺葉切除治療周圍型非小細胞肺癌的安全性和有效性. 現代腫瘤醫學, 2018, 26(10): 1544-1547.
4.	隆治泉. 單孔與多孔胸腔鏡手術對Ⅰ期非小細胞肺癌的臨床療效比較. 臨床醫藥文獻電子雜志, 2018, 5(31): 78.
5.	李志強, 宮心明, 韓孔啟, 等. 單孔與三孔胸腔鏡手術治療早期非小細胞肺癌患者的療效比較. 檢驗醫學與臨床, 2018, 15(6): 888-890.
6.	馬洪飚, 黃偉, 羅鋒, 等. 胸腔鏡單操作孔法與單孔法行肺葉切除術治療早期非小細胞肺癌的臨床效果比較. 廣西醫學, 2017, 39(7): 971-973, 986.
7.	尹遜亮, 周勇安, 趙寧, 等. 單孔及多孔法胸腔鏡手術治療周圍型非小細胞肺癌臨床療效的病例對照研究. 中國胸心血管外科臨床雜志, 2016, 23(11): 1044-1049.
8.	石岱旺, 徐然, 韓云, 等. 單孔與三孔胸腔鏡肺葉切除術治療周圍型肺癌的臨床療效比較. 中國醫科大學學報, 2018, 47(7): 609-611, 616.
9.	Song KS, Park CK, Kim JB. Efficacy of single-port video-assisted thoracoscopic surgery lobectomy compared with triple-port VATS by propensity score matching. Korean J Thorac Cardiovasc Surg, 2017, 50(5): 339-345.
10.	Shen Y, Wang H, Feng M, et al. Single- versus multiple-port thoracoscopic lobectomy for lung cancer: a propensity-matched study. Eur J Cardiothorac Surg, 2016, 49 Suppl 1: i48-i53.
11.	Dai F, Meng S, Mei L, et al. Single-port video-assisted thoracic surgery in the treatment of non-small cell lung cancer: a propensity-matched comparative analysis. J Thorac Dis, 2016, 8(10): 2872-2878.
12.	Son BS, Kim DH. Perioperative and mid-term outcomes after single port versus multi-ports thoracoscopic lobectomy for lung cancer: A propensity matching study. J Thorac Oncol, 2017, 1(Suppl 1): S757-S758.
13.	Han KN, Kim HK, Choi YH. Single-port versus multiport thoracoscopic lobectomy in non-small-cell lung cancer: Propensity-score matched analysis. Innovations (Phila), 2017, 12(Suppl 4): S125.
14.	Rocco G, Khalil M, Jutley R. Uniportal video-assisted thoracoscopic surgery wedge lung biopsy in the diagnosis of interstitial lung diseases. J Thorac Cardiovasc Surg, 2005, 129(4): 947-948.
15.	Gonzalez D, de la Torre M, Paradela M, et al. Video-assisted thoracic surgery lobectomy: 3-year initial experience with 200 cases. Eur J Cardiothorac Surg, 2011, 40(1): e21-e28.
16.	Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken), 2011, 63 (Suppl 11): S240-S252.
17.	Jensen MP, Karoly P, O'Riordan EF, et al. The subjective experience of acute pain. An assessment of the utility of 10 indices. Clin J Pain, 1989, 5(2): 153-159.
18.	West D, Young R, McElnay P, et al. Is uniport thoracoscopic surgery less painful than multiple port approaches? Interact Cardiovasc Thorac Surg, 2015, 20(3): 414.
19.	Doddoli C, Aragon A, Barlesi F, et al. Does the extent of lymph node dissection influence outcome in patients with stageⅠnon-small-cell lung cancer? Eur J Cardiothorac Surg, 2005, 27(4): 680-685.
20.	張皓, 齊海, 王磊, 等. 電視胸腔鏡與開胸手術治療非小細胞肺癌隨機對照研究的系統評價和Meta分析. 中國胸心血管外科臨床雜志, 2015, 22(12): 1087-1094.

1. Rafiemanesh H, Mehtarpour M, Khani F, et al. Epidemiology, incidence and mortality of lung cancer and their relationship with the development index in the world. J Thorac Dis, 2016, 8(6): 1094-1102.
2. Hartwig MG, D'Amico TA. Thoracoscopic lobectomy: the gold standard for early-stage lung cancer? Ann Thorac Surg, 2010, 89(6): S2098-S2101.
3. 王繼振, 劉公哲, 李大宏. 單孔全胸腔鏡下肺葉切除治療周圍型非小細胞肺癌的安全性和有效性. 現代腫瘤醫學, 2018, 26(10): 1544-1547.
4. 隆治泉. 單孔與多孔胸腔鏡手術對Ⅰ期非小細胞肺癌的臨床療效比較. 臨床醫藥文獻電子雜志, 2018, 5(31): 78.
5. 李志強, 宮心明, 韓孔啟, 等. 單孔與三孔胸腔鏡手術治療早期非小細胞肺癌患者的療效比較. 檢驗醫學與臨床, 2018, 15(6): 888-890.
6. 馬洪飚, 黃偉, 羅鋒, 等. 胸腔鏡單操作孔法與單孔法行肺葉切除術治療早期非小細胞肺癌的臨床效果比較. 廣西醫學, 2017, 39(7): 971-973, 986.
7. 尹遜亮, 周勇安, 趙寧, 等. 單孔及多孔法胸腔鏡手術治療周圍型非小細胞肺癌臨床療效的病例對照研究. 中國胸心血管外科臨床雜志, 2016, 23(11): 1044-1049.
8. 石岱旺, 徐然, 韓云, 等. 單孔與三孔胸腔鏡肺葉切除術治療周圍型肺癌的臨床療效比較. 中國醫科大學學報, 2018, 47(7): 609-611, 616.
9. Song KS, Park CK, Kim JB. Efficacy of single-port video-assisted thoracoscopic surgery lobectomy compared with triple-port VATS by propensity score matching. Korean J Thorac Cardiovasc Surg, 2017, 50(5): 339-345.
10. Shen Y, Wang H, Feng M, et al. Single- versus multiple-port thoracoscopic lobectomy for lung cancer: a propensity-matched study. Eur J Cardiothorac Surg, 2016, 49 Suppl 1: i48-i53.
11. Dai F, Meng S, Mei L, et al. Single-port video-assisted thoracic surgery in the treatment of non-small cell lung cancer: a propensity-matched comparative analysis. J Thorac Dis, 2016, 8(10): 2872-2878.
12. Son BS, Kim DH. Perioperative and mid-term outcomes after single port versus multi-ports thoracoscopic lobectomy for lung cancer: A propensity matching study. J Thorac Oncol, 2017, 1(Suppl 1): S757-S758.
13. Han KN, Kim HK, Choi YH. Single-port versus multiport thoracoscopic lobectomy in non-small-cell lung cancer: Propensity-score matched analysis. Innovations (Phila), 2017, 12(Suppl 4): S125.
14. Rocco G, Khalil M, Jutley R. Uniportal video-assisted thoracoscopic surgery wedge lung biopsy in the diagnosis of interstitial lung diseases. J Thorac Cardiovasc Surg, 2005, 129(4): 947-948.
15. Gonzalez D, de la Torre M, Paradela M, et al. Video-assisted thoracic surgery lobectomy: 3-year initial experience with 200 cases. Eur J Cardiothorac Surg, 2011, 40(1): e21-e28.
16. Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken), 2011, 63 (Suppl 11): S240-S252.
17. Jensen MP, Karoly P, O'Riordan EF, et al. The subjective experience of acute pain. An assessment of the utility of 10 indices. Clin J Pain, 1989, 5(2): 153-159.
18. West D, Young R, McElnay P, et al. Is uniport thoracoscopic surgery less painful than multiple port approaches? Interact Cardiovasc Thorac Surg, 2015, 20(3): 414.
19. Doddoli C, Aragon A, Barlesi F, et al. Does the extent of lymph node dissection influence outcome in patients with stageⅠnon-small-cell lung cancer? Eur J Cardiothorac Surg, 2005, 27(4): 680-685.
20. 張皓, 齊海, 王磊, 等. 電視胸腔鏡與開胸手術治療非小細胞肺癌隨機對照研究的系統評價和Meta分析. 中國胸心血管外科臨床雜志, 2015, 22(12): 1087-1094.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Single- versus multiple-port thoracoscopic lobectomy in non-small cell lung cancer: A systematic review and meta-analysis

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