Recruitment maneuvers in patients undergoing thoracic surgery: a meta-analysis

2021 ◽  
Author(s):  
Ming-Chi Hu ◽  
You-Lan Yang ◽  
Tzu-Tao Chen ◽  
Jui-Tai Chen ◽  
Tung-Yu Tiong ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Meta Analysis ◽  
Recruitment Maneuvers

Antifibrinolytics reduces blood loss in thoracic surgery: a systematic review and meta‐analysis

2021 ◽  
Author(s):  
Lowell Leow ◽  
Josiah Ng ◽  
Hai Dong Luo ◽  
Andrew M. T. L. Choong ◽  
Harish Mithiran ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Thoracic Surgery ◽  
Meta Analysis

scholarly journals Robot-assisted thoracic surgery versus video-assisted thoracic surgery for lung lobectomy or segmentectomy in patients with non-small cell lung cancer: a meta-analysis

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jianglei Ma ◽  
Xiaoyao Li ◽  
Shifu Zhao ◽  
Jiawei Wang ◽  
Wujia Zhang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Sensitivity Analysis ◽  
Thoracic Surgery ◽  
Conversion Rate ◽  
Meta Analysis ◽  
Small Cell ◽  
Small Cell Lung ◽  
Robot Assisted ◽  
Short Term

Abstract Background It remains no clear conclusion about which is better between robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for the treatment of patients with non-small cell lung cancer (NSCLC). Therefore, this meta-analysis aimed to compare the short-term and long-term efficacy between RATS and VATS for NSCLC. Methods Pubmed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Medline, and Web of Science databases were comprehensively searched for studies published before December 2020. The quality of the articles was evaluated using the Newcastle-Ottawa Scale (NOS) and the data analyzed using the Review Manager 5.3 software. Fixed or random effect models were applied according to heterogeneity. Subgroup analysis and sensitivity analysis were conducted. Results A total of 18 studies including 11,247 patients were included in the meta-analyses, of which 5114 patients were in the RATS group and 6133 in the VATS group. Compared with VATS, RATS was associated with less blood loss (WMD = − 50.40, 95% CI -90.32 ~ − 10.48, P = 0.010), lower conversion rate (OR = 0.50, 95% CI 0.43 ~ 0.60, P < 0.001), more harvested lymph nodes (WMD = 1.72, 95% CI 0.63 ~ 2.81, P = 0.002) and stations (WMD = 0.51, 95% CI 0.15 ~ 0.86, P = 0.005), shorter duration of postoperative chest tube drainage (WMD = − 0.61, 95% CI -0.78 ~ − 0.44, P < 0.001) and hospital stay (WMD = − 1.12, 95% CI -1.58 ~ − 0.66, P < 0.001), lower overall complication rate (OR = 0.90, 95% CI 0.83 ~ 0.99, P = 0.020), lower recurrence rate (OR = 0.51, 95% CI 0.36 ~ 0.72, P < 0.001), and higher cost (WMD = 3909.87 USD, 95% CI 3706.90 ~ 4112.84, P < 0.001). There was no significant difference between RATS and VATS in operative time, mortality, overall survival (OS), and disease-free survival (DFS). Sensitivity analysis showed that no significant differences were found between the two techniques in conversion rate, number of harvested lymph nodes and stations, and overall complication. Conclusions The results revealed that RATS is a feasible and safe technique compared with VATS in terms of short-term and long-term outcomes. Moreover, more randomized controlled trials comparing the two techniques with rigorous study designs are still essential to evaluate the value of robotic surgery for NSCLC.

scholarly journals Comparison of non-intubated and intubated video-assisted thoracoscopic surgeries of major pulmonary resections for lung cancer—a meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Wenfei Xue ◽  
Guochen Duan ◽  
Xiaopeng Zhang ◽  
Hua Zhang ◽  
Qingtao Zhao ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Thoracic Surgery ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Chest Tube ◽  
Meta Analysis ◽  
Tube Placement ◽  
Postoperative Complication Rate ◽  
Chest Tube Placement ◽  
Video Assisted

Abstract Objective The aim of this study was to compare the safety feasibility and safety feasibility of non-intubated (NIVATS) and intubated video-assisted thoracoscopic surgeries (IVATS) during major pulmonary resections. Methods A meta-analysis of eight studies was conducted to compare the real effects of two lobectomy or segmentectomy approaches during major pulmonary resections. Results Results showed that the patients using NIVATS had a greatly shorter hospital stay and chest-tube placement time (weighted mean difference (WMD): − 1.04 days; 95% CI − 1.50 to − 0.58; P < 0.01) WMD − 0.71 days; 95% confidence interval (CI), − 1.08 to − 0.34; P < 0.01, respectively) while compared to those with IVATS. There were no significant differences in postoperative complication rate, surgical duration, and the number of dissected lymph nodes. However, through the analysis of highly selected patients with lung cancer in early stage, the rate of postoperative complication in the NIVATS group was lower than that in the IVATS group [odds ratio (OR) 0.44; 95% CI 0.21–0.92; P = 0.03, I2 = 0%]. Conclusions Although the comparable postoperative complication rate was observed for major thoracic surgery in two surgical procedures, the NIVATS method could significantly shorten the hospitalized stay and chest-tube placement time compared with IVATS. Therefore, for highly selected patients, NIVATS is regarded as a safe and technically feasible procedure for major thoracic surgery. The assessment of the safety and feasibility for patients undergoing NIVATS needs further multi-center prospective clinical trials.

scholarly journals Sex and the Risk of AKI Following Cardio-thoracic Surgery: A Meta-Analysis

2016 ◽  
Vol 11 (12) ◽  
pp. 2113-2122 ◽  
Author(s):  
Joel Neugarten ◽  
Sandipani Sandilya ◽  
Beenu Singh ◽  
Ladan Golestaneh
Keyword(s):  
Thoracic Surgery ◽  
Meta Analysis

Video-Assisted Thoracic Surgery in Lung Cancer Resection

2007 ◽  
Vol 2 (6) ◽  
pp. 261-292 ◽  
Author(s):  
Davy Cheng ◽  
Robert J. Downey ◽  
Kemp Kernstine ◽  
Rex Stanbridge ◽  
Hani Shennib ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Blood Loss ◽  
Thoracic Surgery ◽  
Open Surgery ◽  
Meta Analysis ◽  
Risk Of Death ◽  
Patient Reported ◽  
Mean Differences

Objectives This meta-analysis sought to determine whether videoassisted thoracic surgery (VATS) improves clinical and resource outcomes compared with thoracotomy (OPEN) in adults undergoing lobectomy for nonsmall cell lung cancer. Methods A comprehensive search was undertaken to identify all randomized (RCT) and nonrandomized (non-RCT) controlled trials comparing VATS with OPEN thoracotomy available up to April 2007. The primary outcome was survival. Secondary outcomes included any other reported clinical outcome and resource utilization. Odds ratios (OR), weighted mean differences (WMD), or standardized mean differences (SMD), and their 95% confidence intervals (95% CI) were analyzed as appropriate. Results Baseline prognosis was more favorable for VATS (more females, smaller tumor size, less advanced stage, histology associated with peripheral location and with more indolent disease) than for OPEN in non-RCTs, but not RCT. Postoperative complications were significantly reduced in the VATS group compared with OPEN surgery when both RCT and non-RCT were considered in aggregate (OR 0.48, 95% CI 0.32–0.70). Although overall blood loss was significantly reduced with VATS compared with OPEN (–80 mL, 95% CI −110 to −50 mL), the incidence of excessive blood loss (generally defined as >500 mL) and incidence of re-exploration for bleeding was not significantly reduced. Pain measured via visual analog scales (10-point VAS) was significantly reduced by <1 point on day 1, by >2 points at 1 week, and by <1 point at week 2 to 4. Similarly, analgesia requirements were significantly reduced in the VATS group. Postoperative vital capacity was significantly improved (WMD 20, 95% CI 15–25), and at 1 year was significantly greater for VATS versus OPEN surgery (WMD 7, 95% CI 2–12). The incidence of patients reporting limited activity at 3 months was reduced (OR 0.04, 95% CI 0.00–0.82), and time to full activity was significantly reduced in the VATS versus OPEN surgery (WMD −1.5, 95% CI −2.1 to −0.9). Overall patient-reported physical function scores did not differ between groups at 3 years follow-up. Hospital length of stay was significantly reduced by 2.6 days despite increased 16 minutes of operating time for VATS versus OPEN. The incidence of cancer recurrence (local or distal) was not significantly different, but chemotherapy delays were significantly reduced for VATS versus OPEN (OR 0.15, 95% CI 0.06–0.38). The need for chemotherapy reduction was also decreased (OR 0.37, 95% CI 0.16–0.87), and the number of patients who did not receive at least 75% of their planned chemotherapy without delays were reduced (OR 0.41, 95% CI 0.18–0.93). The risk of death was not significantly reduced when RCTs were considered alone; however, when non-RCTs (n = 18) were included, the risk of death at 1 to 5 years was significantly reduced (OR 0.72, 95% CI 0.55–0.94; P = 0.02) for VATS versus OPEN. Stage-specific survival to 5 years was not significantly different between groups. Conclusions This meta-analysis suggests that there may be some short term, and possibly even long-term, advantages to performing lung resections with VATS techniques rather than through conventional thoracotomy. Overall, VATS for lobectomy may reduce acute and chronic pain, perioperative morbidity, and improve delivery of adjuvant therapies, without a decrease in stage specific long-term survival. However, the results are largely dependent on non-RCTs, and future adequately powered randomized trials with long-term follow-up are encouraged.

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