Single-incision Video-assisted Thoracic Surgery versus Conventional Multiple Ports Surgery for Lung Cancer: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 HUANGGuo-gang ,  SHENXue-yuan

Department of Thoracic Surgery, Yongchuan Hospital of Chongqing Medical University, Yongchuan 402160, China;

Corresponding?author：

SHENXue-yuan, Email: sxy1965@126.com

Keywords：

Single-incision video-assisted thoracic surgery; Multiple ports video-assisted thoracic surgery; Lung cancer; Systematic review; Meta-analysis; Cohort study

DOI：

10.7507/1672-2531.20160162

Video：

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Objective To systematically evaluate the effectiveness and safety of single-incision video-assisted thoracic surgery (VATS) versus conventional multiple ports VATS for lung cancer. Methods We searched databases including PubMed, The Cochrane Library (Issue 3, 2016), EMbase, CBM, CNKI and WanFang Data from inception to April 2016, to collect randomized controlled trials (RCTs) and cohort studies comparing single-incision VATS and conventional multiple ports VATS for lung cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. Results A total of 9 cohort studies involving 1 318 patients were finally included. The results of meta-analysis showed that: compared with the conventional multiple ports VATS group, the single-incision VATS group had shorter chest drainage time (MD=-0.70, 95%CI -1.38 to -0.02, P=0.04), shorter hospital stay (MD=-0.52, 95%CI -0.91 to -0.14, P=0.007), less amount of intraoperative bleeding (MD=-18.49, 95%CI -33.61 to -3.37, P=0.02), lower VAS score at 1 and 3 days after surgery (MD=-0.32, 95%CI -0.51 to -0.14, P=0.000 7; MD=-0.48, 95%CI -0.58 to -0.38, P < 0.000 01). Meanwhile, there were no statistical differences between both groups in operation time (MD=-3.40, 95%CI -13.65 to 6.85, P=0.52), the postoperative complications (OR=0.91, 95%CI 0.65 to 1.27, P=0.56), the number of lymph node dissection (MD=-0.79, 95%CI -2.35 to 0.77, P=0.32), the total cost (MD=0.47, 95%CI -0.39 to 1.32, P=0.28), the intraoperative conversion rate (OR=0.92, 95%CI 0.44 to 1.93, P=0.82) and VAS score at 7 days after surgery (MD=-1.18, 95%CI -2.42 to 0.07, P=0.06). Conclusion Current evidence shows, single-incision VATS is superior in the surgical trauma to conventional multiple ports VATS in the treatment of lung cancer, However, due to the limited quality and quantity of included studies, more large-scale, high-quality studies are needed to verify the above conclusion.

Citation： HUANGGuo-gang, SHENXue-yuan. Single-incision Video-assisted Thoracic Surgery versus Conventional Multiple Ports Surgery for Lung Cancer: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(9): 1056-1063. doi: 10.7507/1672-2531.20160162 Copy

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2.	Iwata H. Minimally invasive pulmonary surgery for lung cancer, up to date. Gen Thorac Cardiovasc Surg, 2013, 61(8): 449-454.
3.	Swanson SJ, Herndon JE Ⅱ, D'Amico TA, et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802-a prospective, multi-institution feasibility study. J Clin Oncol, 2007, 25(31): 4993-4997.
4.	Salati M, Brunelli A, Xiume F, et al. Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax:clinical and economic analysis in comparison to the traditional approach. Interact Cardiovasc Thorac Surg, 2008, 7(1): 63-66.
5.	Berlanga LA, Gigirey O. Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax using a single-incision laparoscopic surgery port: a feasible and safe procedure. Surg Endosc, 2011, 25(6): 2044-2047.
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8.	晉云鵬, 盧喜科, 張遜, 等.單孔與三孔胸腔鏡肺葉切除術的臨床療效對比.天津醫藥, 2016, 44(1): 101-104.
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10.	朱啟航, 肖海平, 何哲, 等. 3種電視胸腔鏡下手術治療非小細胞肺癌早期創傷反應的比較.實用醫學雜志, 2016, 32(2): 231-235.
11.	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(1): i48-53.
12.	葉辰陽, 柴瑩.單孔與多孔胸腔鏡下肺葉切除術圍手術期情況的對比.浙江大學, 2015, 1-30.
13.	謝錦寶, 陳椿.單孔胸腔鏡與三孔胸腔鏡行肺癌根治術的臨床對比研究.福建醫科大學, 2015, 1-30.
14.	張海, 劉繼先.單孔與三孔法電視胸腔鏡治療原發性肺癌效果比較.汕頭大學, 2015, 1-31.
15.	Liu CC, Shih CS, Pennarun N, et al. Transition from a multiport technique to a single-port technique for lung cancer surgery: is lymph node dissection inferior using the single-port technique? Eur J Cardiothorac Surg, 2016, 49(1): i64-72.
16.	McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1, 100 cases. Ann Thorac Surg, 2006, 81(2): 421-426.
17.	Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
18.	Gonzalez-Rivas D, Fieira E, Delgado M, et al. Is uniportal thoracoscopic surgery a feasible approach for advanced stages of non-small cell lung cancer? J Thorac Dis, 2014, 6(6): 641-648.
19.	Sihoe AD. The evolution of minimally invasive thoracic surgery: implications for the practice of uniportal thoracoscopic surgery. J Thorac Dis, 2014, 6(6): 604-617.
20.	劉家全.單孔胸腔鏡手術, 越微創越好?臨床與病理雜志, 2015, 35(10): 1763-1765.
21.	Tu CC, Hsu PK. Global development and current evidence of uniportal thoracoscopic surgery. J Thorac Dis, 2016, 8(3): S308-318.
22.	Tamura M, Shimizu Y, Hashizume Y. Pain following thoracoscopic surgery: retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery. J Cardiothorac Surg, 2013, 12(8): 153.
23.	由兆磊, 李德生, 錢昆杰, 等.單孔胸腔鏡與傳統三孔腔鏡手術治療自發性氣胸療效比較的Meta分析.中國循證醫學雜志, 2015, 15(8): 945-950.

1. Naidoo R, Windsor MN, Goldstraw P. Surgery in 2013 and beyond. J Thorac Dis, 2013, 5(5): S593-606.
2. Iwata H. Minimally invasive pulmonary surgery for lung cancer, up to date. Gen Thorac Cardiovasc Surg, 2013, 61(8): 449-454.
3. Swanson SJ, Herndon JE Ⅱ, D'Amico TA, et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802-a prospective, multi-institution feasibility study. J Clin Oncol, 2007, 25(31): 4993-4997.
4. Salati M, Brunelli A, Xiume F, et al. Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax:clinical and economic analysis in comparison to the traditional approach. Interact Cardiovasc Thorac Surg, 2008, 7(1): 63-66.
5. Berlanga LA, Gigirey O. Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax using a single-incision laparoscopic surgery port: a feasible and safe procedure. Surg Endosc, 2011, 25(6): 2044-2047.
6. Avariable at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
7. Chung JH, Choi YS, Cho JH, et al. Uniportal video-assisted thoracoscopic lobectomy: an alternative to conventional thoracoscopic lobectomy in lung cancer surgery? Interact CardioVasc Thorac Surg, 2015, 20(6): 813-819.
8. 晉云鵬, 盧喜科, 張遜, 等.單孔與三孔胸腔鏡肺葉切除術的臨床療效對比.天津醫藥, 2016, 44(1): 101-104.
9. Hirai K, Takeuchi S, Usuda J. Single-incision thoracoscopic surgery and conventional video-assisted thoracoscopic surgery: a retrospective comparative study of perioperative clinical outcomes. Eur J Cardiothorac Surg, 2016, 49(1): i37-41.
10. 朱啟航, 肖海平, 何哲, 等. 3種電視胸腔鏡下手術治療非小細胞肺癌早期創傷反應的比較.實用醫學雜志, 2016, 32(2): 231-235.
11. 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(1): i48-53.
12. 葉辰陽, 柴瑩.單孔與多孔胸腔鏡下肺葉切除術圍手術期情況的對比.浙江大學, 2015, 1-30.
13. 謝錦寶, 陳椿.單孔胸腔鏡與三孔胸腔鏡行肺癌根治術的臨床對比研究.福建醫科大學, 2015, 1-30.
14. 張海, 劉繼先.單孔與三孔法電視胸腔鏡治療原發性肺癌效果比較.汕頭大學, 2015, 1-31.
15. Liu CC, Shih CS, Pennarun N, et al. Transition from a multiport technique to a single-port technique for lung cancer surgery: is lymph node dissection inferior using the single-port technique? Eur J Cardiothorac Surg, 2016, 49(1): i64-72.
16. McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1, 100 cases. Ann Thorac Surg, 2006, 81(2): 421-426.
17. Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
18. Gonzalez-Rivas D, Fieira E, Delgado M, et al. Is uniportal thoracoscopic surgery a feasible approach for advanced stages of non-small cell lung cancer? J Thorac Dis, 2014, 6(6): 641-648.
19. Sihoe AD. The evolution of minimally invasive thoracic surgery: implications for the practice of uniportal thoracoscopic surgery. J Thorac Dis, 2014, 6(6): 604-617.
20. 劉家全.單孔胸腔鏡手術, 越微創越好?臨床與病理雜志, 2015, 35(10): 1763-1765.
21. Tu CC, Hsu PK. Global development and current evidence of uniportal thoracoscopic surgery. J Thorac Dis, 2016, 8(3): S308-318.
22. Tamura M, Shimizu Y, Hashizume Y. Pain following thoracoscopic surgery: retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery. J Cardiothorac Surg, 2013, 12(8): 153.
23. 由兆磊, 李德生, 錢昆杰, 等.單孔胸腔鏡與傳統三孔腔鏡手術治療自發性氣胸療效比較的Meta分析.中國循證醫學雜志, 2015, 15(8): 945-950.

Chinese Journal of Evidence-Based Medicine

Single-incision Video-assisted Thoracic Surgery versus Conventional Multiple Ports Surgery for Lung Cancer: A Meta-analysis

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