The influence of different operation to pulmonary function in patients with early stage non-small cell lung cancer: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

FENG Haiming ¹ ^# , ZHAO Ye ² ^# , MA Jianxing ¹ , JING Tao ¹ ,  LI Bin ¹ ,  WANG Cheng ¹ , JIANG Peng ¹

1. Department of Thoracic Surgery, the Second Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;
2. The Evidence-Based Medicine Center of Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding?author：

LI Bin, Email: dr.leebin@outlook.com; WANG Cheng, Email: wangc88@sina.com

Keywords：

Early stage non-small cell lung cancer; Lung cancer operation; Thoracoscope resection of lung cancer; Thoracotomy; Lobectomy; Segmentectomy; Pulmonary function; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.201703083

Video：

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ObjectiveTo systematically review the postoperative recovery of lung function in patients with early stage non-small cell lung cancer (NSCLC) after different operation, such as lobectomy versus segmentectomy and video-assisted thoracoscopic surgery (VATS) versus traditional open chest surgery.MethodsClinical studies about effect of different surgical methods on lung function in patients with early NSCLC were searched from PubMed, EMbase, The Cochrane Library, CBM and CNKI databases from inception to October 1^st, 2016. Two researchers independently screened literature, extracted data and evaluated the risk of bias of included studies, and then meta-analysis was conducted by RevMan 5.3 and MetaAnalyst software.ResultsA total of 25 studies involving 2 924 patients were included. The results of meta-analysis showed that: compared with lobectomy group, one-second rate difference (ΔFEV₁%) (MD=–0.03, 95%CI –0.03 to –0.03, P<0.001) and predictive value of forced vital capacity difference (ΔFVC%) (MD=–0.09, 95%CI –0.11 to –0.06, P<0.001) of preoperative to postoperative in segmentectomy group were higher. However, there was no significant difference between two groups in first second forced expiratory volume difference (ΔFEV₁) (MD=0.01, 95%CI –0.10 to 0.11, P=0.92). Compared with thoracotomy group, VATS group had lower ΔFEV₁ (MD=–0.19, 95%CI –0.27 to –0.10, P<0.0001), ΔFVC (MD=–0.20, 95%CI –0.37 to –0.03, P=0.02), ΔFEV₁% (MD=–0.03, 95%CI –0.06 to –0.01, P<0.001) of preoperative to postoperative (≤3 months), and maximum minute ventilation (ΔMVV) (MD=–5.59, 95%CI –10.38 to –1.52, P=0.008) of preoperative to postoperative (≥6 months). However, there were no statistically significant differences in difference of carbon monoxide diffusion rate (ΔDLCO%) (MD=–0.04, 95%CI –0.09 to 0.02, P=0.16), ΔFEV₁% (MD=–0.02, 95%CI –0.06 to 0.02, P=0.32) and ΔFEV₁ (MD=1.13, 95%CI –0.92 to 3.18, P=0.28).ConclusionThe protective effect of segmentectomy on postoperative pulmonary function is better than that of lobectomy. VATS has a protective effect on the ventilation function within 3 months and 6 months after surgery. Due to limited quantity and quality of included studies, the above conclusions are needed to be validated by more high quality studies.

Citation： FENG Haiming, ZHAO Ye, MA Jianxing, JING Tao, LI Bin, WANG Cheng, JIANG Peng. The influence of different operation to pulmonary function in patients with early stage non-small cell lung cancer: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(8): 949-958. doi: 10.7507/1672-2531.201703083 Copy

1.	Deng B, Cassivi SD, De AM, et al. Clinical outcomes and changes in lung function after segmentectomy versus lobectomy for lung cancer cases. J Thorac Cardiovasc Surg, 2014, 148(4): 1186-1192.
2.	Liu HP, Chang CH, Lin PJ, et al. Thoracoscopic-assisted lobectomy: preliminary experience and results. Chest, 1995, 107(3): 853.
3.	Landreneau RJ, Hazelrigg SR, Mack MJ, et al. Postoperative pain-related morbidity: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg, 1994, 56(6): 1285-1289.
4.	Landreneau RJ, Mack MJ, Hazelrigg SR, et al. Prevalence of chronic pain after pulmonary resection by thoracotomy or video-assisted thoracic surgery. J Thorac Cardiovasc Surg, 1994, 107(4): 1085-1086.
5.	Shapiro M, Weiser TS, Wisnivesky JP, et al. Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage I lung cancer. J Thorac Cardiovasc Surg, 2009, 137(6): 1388-1393.
6.	Yoshimoto K, Nomori H, Mori T, et al. Postoperative change in pulmonary function of the ipsilateral preserved lung after segmentectomy versus lobectomy. Eur J Cardiothorac, 2010, 37(1): 36-39.
7.	Schuchert MJ, Normolle DP, Mccormick KN, et al. Anatomic segmentectomy versus lobectomy for clinical stage I non-small cell lung cancer: a propensity-matched analysis. J Clin Oncol, 2012, 32(23): 2449-2455.
8.	Suzuki H, Morimoto J, Mizobuchi T, et al. Does segmentectomy really preserve the pulmonary function better than lobectomy for patients with early-stage lung cancer. Surg Today, 2016, 47(4): 463-469.
9.	Nakata M, Saeki H, Yokoyama N, et al. Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg, 2000, 70(3): 938-941.
10.	Keenan RJ, Landreneau RJ, Maley RH, et al. Segmental resection spares pulmonary function in patients with stage I lung cancer. Ann Thorac Surg, 2004, 78(1): 228-233.
11.	Yatsuyanagi E, Sato K, Murakami K, et al. Comparison of postoperative lung function between segmentectomy and lobectomy in patients with lung carcinoma. Kyobu Geka, 2005, 58(6): 466-469.
12.	Mondello B, Sibilio M, Pavone A, et al. "Intentionally" limited pulmonary resection versus lobectomy for the treatment of peripheral stage IA non-small cell lung cancers. G Chir, 2007, 28(1-2): 7-12.
13.	Kashiwabara K, Sasaki J, Mori T, et al. Relationship between functional preservation after segmentectomy and volume-reduction effects after lobectomy in stage I non-small cell lung cancer patients with emphysema. J Thorac Oncol, 2009, 4(9): 1111-1116.
14.	Yoshimoto K, Nomori H, Mori T, et al. Quantification of the impact of segmentectomy on pulmonary function by perfusion single-photon-emission computed tomography and multidetector computed tomography. J Thorac Cardiovasc Surg, 2009, 137(5): 1200-1205.
15.	Yoshimoto K, Nomori H, Mori T, et al. A segmentectomy of the right upper lobe has an advantage over a right upper lobectomy regarding the preservation of the functional volume of the right middle lobe: analysis by perfusion single-photon emission computed tomography/computed tomography. Surg Today, 2010, 40(7): 614-619.
16.	車國衛, 喻鵬銘, 蘇建華, 等. 胸腔鏡和開放肺葉切除術對肺癌患者心肺運動耐力的影響. 四川大學學報(醫學版), 2013, 44(1): 122-125.
17.	Saito H, Nakagawa T, Ito M, et al. Pulmonary function after lobectomy versus segmentectomy in patients with stage I non-small cell lung cancer. World J Surg, 2014, 38(8): 2025-2031.
18.	張衛強, 左建新, 譚健, 等. 電視胸腔鏡手術對老年非小細胞肺癌患者術后心肺并發癥的影響分析. 中國全科醫學, 2014, 17(2): 220-222.
19.	Hwang Y, Kang CH, Kim HS, et al. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy on the patients with non-small cell lung cancer: a propensity score matching study. Eur J Cardiothorac Surg, 2015, 48(2): 273-278.
20.	Xue Y, Wang YY, Zhang K, et al. A study of complete video-assisted thoracoscopic surgery lobectomy in treatment of elderly patients with non-small cell lung cancer: curative effect and impact on clinical prognosis. Cell Biochem Biophys, 2015, 73(2): 399-404.
21.	張克, 趙得堡. 全胸腔鏡肺葉切除術治療老年非小細胞肺癌的近遠期療效分析. 重慶醫學, 2015, 44(34): 4829-4832.
22.	李國強, 駱楊. 常規開胸和電視胸腔鏡肺葉切除術對肺癌患者術后心、肺運動耐力的影響分析. 中國實用醫藥, 2016, 11(10): 64-65.
23.	趙純, 曹隆想, 張翀, 等. 胸腔鏡下肺段切除術與肺葉切除術治療肺癌的近期療效評估. 華中科技大學學報醫學版, 2015, 44(2): 213-216.
24.	張志鋒, 洪祎純, 黃豪達, 等. 腔鏡微創手術對肺癌患者術后肺功能的影響分析. 齊齊哈爾醫學院學報, 2015(12): 1739-1740.
25.	張艷嬌, 高禹舜. 肺癌胸腔鏡肺葉切除、胸腔鏡肺段切除與開胸肺葉切除術后對肺功能影響的研究. 中國肺癌雜志, 2016, 19(10): 700-704.
26.	于軍, 高媛. 肺段與肺葉切除治療早期 NSCLC 效果及肺功能比較. 西南國防醫藥, 2016, 26(8): 890-892.
27.	趙曉龍, 孟勝藍, 蔡云婷, 等. 胸腔鏡下肺葉切除術和肺段切除術治療肺癌患者臨床療效及其對肺功能影響的比較. 疑難病雜志, 2016, 15(7): 690-693.
28.	范明, 王永利, 錢佳音. 不同肺葉切除術對 Ⅰ～Ⅱ 期非小細胞肺癌患者術后肺功能和生活質量的影響比較. 實用癌癥雜志, 2016, 31(8): 1302-1304.
29.	楊欣, 曾興建, 付娟. 電視胸腔鏡與傳統手術對治療非小細胞肺癌患者心肺功能影響分析. 臨床和實驗醫學雜志, 2016, 15(11): 1087-1089.
30.	魏合成, 張海霞. 全胸腔鏡肺葉切除治療肺癌的臨床效果及對患者免疫功能、炎性因子和生存質量的影響. 河北醫藥, 2016, 38(11): 1688-1690.
31.	龍志華, 黃健文. 完全胸腔鏡下肺葉與肺段切除術治療 Ⅰ 期肺癌的臨床對比研究. 白求恩醫學雜志, 2016, 14(3): 301-302.
32.	Echavarria MF, Cheng AM, Velez-Cubian FO, et al. Comparison of pulmonary function tests and perioperative outcomes after robotic-assisted pulmonary lobectomy vs. segmentectomy. SAfr J Surg, 2016, 212(6): 1175-1182.
33.	Park TY, Park YS. Long-term respiratory function recovery in patients with stage I lung cancer receiving video-assisted thoracic surgery versus thoracotomy. J Thorac Dis, 2016, 8(1): 161-168.
34.	林文苑, 唐杰, 曾波航. 手術治療局限期小細胞肺癌療效的 Meta 分析. 中山大學學報(醫學科學版), 2015, 36(6): 943-948.
35.	Juhl B, Frost N. A comparison between measured and calculated changes in the lung function after operation for pulmonary cancer. Acta Anaesth Scand, 1975, 19(57): 39-45.
36.	Nishio W, Yoshimura M, Maniwa Y, et al. Re-assessment of intentional extended segmentectomy for clinical T1aN0 non-small cell lung cancer. Ann Thorac Surg, 2016, 102(5): 1702-1710.
37.	張國紅, 操敏. 肺癌患者彌散功能特點及臨床意義探討. 中國肺癌雜志, 2002, 5(3): 207-210.
38.	操敏, 李琦, 張國紅, 等. 肺癌患者運動心肺功能的特點及影響因素的觀察. 中國肺癌雜志, 2002, 5(6): 123-128.

1. Deng B, Cassivi SD, De AM, et al. Clinical outcomes and changes in lung function after segmentectomy versus lobectomy for lung cancer cases. J Thorac Cardiovasc Surg, 2014, 148(4): 1186-1192.
2. Liu HP, Chang CH, Lin PJ, et al. Thoracoscopic-assisted lobectomy: preliminary experience and results. Chest, 1995, 107(3): 853.
3. Landreneau RJ, Hazelrigg SR, Mack MJ, et al. Postoperative pain-related morbidity: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg, 1994, 56(6): 1285-1289.
4. Landreneau RJ, Mack MJ, Hazelrigg SR, et al. Prevalence of chronic pain after pulmonary resection by thoracotomy or video-assisted thoracic surgery. J Thorac Cardiovasc Surg, 1994, 107(4): 1085-1086.
5. Shapiro M, Weiser TS, Wisnivesky JP, et al. Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage I lung cancer. J Thorac Cardiovasc Surg, 2009, 137(6): 1388-1393.
6. Yoshimoto K, Nomori H, Mori T, et al. Postoperative change in pulmonary function of the ipsilateral preserved lung after segmentectomy versus lobectomy. Eur J Cardiothorac, 2010, 37(1): 36-39.
7. Schuchert MJ, Normolle DP, Mccormick KN, et al. Anatomic segmentectomy versus lobectomy for clinical stage I non-small cell lung cancer: a propensity-matched analysis. J Clin Oncol, 2012, 32(23): 2449-2455.
8. Suzuki H, Morimoto J, Mizobuchi T, et al. Does segmentectomy really preserve the pulmonary function better than lobectomy for patients with early-stage lung cancer. Surg Today, 2016, 47(4): 463-469.
9. Nakata M, Saeki H, Yokoyama N, et al. Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg, 2000, 70(3): 938-941.
10. Keenan RJ, Landreneau RJ, Maley RH, et al. Segmental resection spares pulmonary function in patients with stage I lung cancer. Ann Thorac Surg, 2004, 78(1): 228-233.
11. Yatsuyanagi E, Sato K, Murakami K, et al. Comparison of postoperative lung function between segmentectomy and lobectomy in patients with lung carcinoma. Kyobu Geka, 2005, 58(6): 466-469.
12. Mondello B, Sibilio M, Pavone A, et al. "Intentionally" limited pulmonary resection versus lobectomy for the treatment of peripheral stage IA non-small cell lung cancers. G Chir, 2007, 28(1-2): 7-12.
13. Kashiwabara K, Sasaki J, Mori T, et al. Relationship between functional preservation after segmentectomy and volume-reduction effects after lobectomy in stage I non-small cell lung cancer patients with emphysema. J Thorac Oncol, 2009, 4(9): 1111-1116.
14. Yoshimoto K, Nomori H, Mori T, et al. Quantification of the impact of segmentectomy on pulmonary function by perfusion single-photon-emission computed tomography and multidetector computed tomography. J Thorac Cardiovasc Surg, 2009, 137(5): 1200-1205.
15. Yoshimoto K, Nomori H, Mori T, et al. A segmentectomy of the right upper lobe has an advantage over a right upper lobectomy regarding the preservation of the functional volume of the right middle lobe: analysis by perfusion single-photon emission computed tomography/computed tomography. Surg Today, 2010, 40(7): 614-619.
16. 車國衛, 喻鵬銘, 蘇建華, 等. 胸腔鏡和開放肺葉切除術對肺癌患者心肺運動耐力的影響. 四川大學學報(醫學版), 2013, 44(1): 122-125.
17. Saito H, Nakagawa T, Ito M, et al. Pulmonary function after lobectomy versus segmentectomy in patients with stage I non-small cell lung cancer. World J Surg, 2014, 38(8): 2025-2031.
18. 張衛強, 左建新, 譚健, 等. 電視胸腔鏡手術對老年非小細胞肺癌患者術后心肺并發癥的影響分析. 中國全科醫學, 2014, 17(2): 220-222.
19. Hwang Y, Kang CH, Kim HS, et al. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy on the patients with non-small cell lung cancer: a propensity score matching study. Eur J Cardiothorac Surg, 2015, 48(2): 273-278.
20. Xue Y, Wang YY, Zhang K, et al. A study of complete video-assisted thoracoscopic surgery lobectomy in treatment of elderly patients with non-small cell lung cancer: curative effect and impact on clinical prognosis. Cell Biochem Biophys, 2015, 73(2): 399-404.
21. 張克, 趙得堡. 全胸腔鏡肺葉切除術治療老年非小細胞肺癌的近遠期療效分析. 重慶醫學, 2015, 44(34): 4829-4832.
22. 李國強, 駱楊. 常規開胸和電視胸腔鏡肺葉切除術對肺癌患者術后心、肺運動耐力的影響分析. 中國實用醫藥, 2016, 11(10): 64-65.
23. 趙純, 曹隆想, 張翀, 等. 胸腔鏡下肺段切除術與肺葉切除術治療肺癌的近期療效評估. 華中科技大學學報醫學版, 2015, 44(2): 213-216.
24. 張志鋒, 洪祎純, 黃豪達, 等. 腔鏡微創手術對肺癌患者術后肺功能的影響分析. 齊齊哈爾醫學院學報, 2015(12): 1739-1740.
25. 張艷嬌, 高禹舜. 肺癌胸腔鏡肺葉切除、胸腔鏡肺段切除與開胸肺葉切除術后對肺功能影響的研究. 中國肺癌雜志, 2016, 19(10): 700-704.
26. 于軍, 高媛. 肺段與肺葉切除治療早期 NSCLC 效果及肺功能比較. 西南國防醫藥, 2016, 26(8): 890-892.
27. 趙曉龍, 孟勝藍, 蔡云婷, 等. 胸腔鏡下肺葉切除術和肺段切除術治療肺癌患者臨床療效及其對肺功能影響的比較. 疑難病雜志, 2016, 15(7): 690-693.
28. 范明, 王永利, 錢佳音. 不同肺葉切除術對 Ⅰ～Ⅱ 期非小細胞肺癌患者術后肺功能和生活質量的影響比較. 實用癌癥雜志, 2016, 31(8): 1302-1304.
29. 楊欣, 曾興建, 付娟. 電視胸腔鏡與傳統手術對治療非小細胞肺癌患者心肺功能影響分析. 臨床和實驗醫學雜志, 2016, 15(11): 1087-1089.
30. 魏合成, 張海霞. 全胸腔鏡肺葉切除治療肺癌的臨床效果及對患者免疫功能、炎性因子和生存質量的影響. 河北醫藥, 2016, 38(11): 1688-1690.
31. 龍志華, 黃健文. 完全胸腔鏡下肺葉與肺段切除術治療 Ⅰ 期肺癌的臨床對比研究. 白求恩醫學雜志, 2016, 14(3): 301-302.
32. Echavarria MF, Cheng AM, Velez-Cubian FO, et al. Comparison of pulmonary function tests and perioperative outcomes after robotic-assisted pulmonary lobectomy vs. segmentectomy. SAfr J Surg, 2016, 212(6): 1175-1182.
33. Park TY, Park YS. Long-term respiratory function recovery in patients with stage I lung cancer receiving video-assisted thoracic surgery versus thoracotomy. J Thorac Dis, 2016, 8(1): 161-168.
34. 林文苑, 唐杰, 曾波航. 手術治療局限期小細胞肺癌療效的 Meta 分析. 中山大學學報(醫學科學版), 2015, 36(6): 943-948.
35. Juhl B, Frost N. A comparison between measured and calculated changes in the lung function after operation for pulmonary cancer. Acta Anaesth Scand, 1975, 19(57): 39-45.
36. Nishio W, Yoshimura M, Maniwa Y, et al. Re-assessment of intentional extended segmentectomy for clinical T1aN0 non-small cell lung cancer. Ann Thorac Surg, 2016, 102(5): 1702-1710.
37. 張國紅, 操敏. 肺癌患者彌散功能特點及臨床意義探討. 中國肺癌雜志, 2002, 5(3): 207-210.
38. 操敏, 李琦, 張國紅, 等. 肺癌患者運動心肺功能的特點及影響因素的觀察. 中國肺癌雜志, 2002, 5(6): 123-128.

Chinese Journal of Evidence-Based Medicine

The influence of different operation to pulmonary function in patients with early stage non-small cell lung cancer: a meta-analysis

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