Minimally invasive surgery versus thoracotomy for resectable stage II and III non-small-cell lung cancers: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Haifeng Shen ◽  
Xin Wang ◽  
Yuntao Nie ◽  
Kai Zhang ◽  
Zihan Wei ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Meta Analysis ◽  
Small Cell ◽  
Mean Difference ◽  
Perioperative Outcomes ◽  
Small Cell Lung ◽  
Lung Cancers ◽  
Standardized Mean Difference

Abstract   OBJECTIVES The study aimed to compare the long-term oncological efficacy and perioperative outcomes of patients with locally advanced non-small-cell lung cancers who underwent minimally invasive surgery (MIS) or thoracotomy. METHODS Cochrane Library, PubMed and EMBASE databases, ClinicalTrials.gov and reference lists were searched for relevant studies. Two reviewers independently assessed the quality of the studies. Recurrence-free survival (RFS) and overall survival (OS) and perioperative outcomes were synthesized. Random-effects models were used to summarize hazard ratios (HRs), relative risks and standardized mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS Twenty-three retrospective cohort studies were reviewed with a total of 3281 patients, of whom 1376 (41.9%) received MIS and 1905 (58.1%) received thoracotomy. Meta-analysis showed no significant differences in both RFS (HR, 1.02; 95% CI, 0.89–1.17; P = 0.78) and OS (HR, 0.91; 95% CI, 0.80–1.03; P = 0.15) between MIS versus thoracotomy approaches. Similar results were observed in propensity score matched studies (RFS, HR, 0.94; 95% CI, 0.73–1.20; P = 0.62; OS, HR, 0.96; 95% CI, 0.72–1.30; P = 0.81). No significant difference was found in lymph node clearance and margin positivity. As for perioperative outcomes, MIS was associated with a significant reduction in postoperative complications (relative risk, 0.83; P = 0.01), intraoperative blood loss (standardized mean difference, −0.68; P = 0.007), chest tube drainage (standardized mean difference, −0.38; P = 0.03) and length of hospital stay (standardized mean difference, −0.79; P = 0.002) when compared with thoracotomy. CONCLUSIONS The use of MIS for resectable stage II and III non-small-cell lung cancers is an eligible alternative to conventional thoracotomy without compromising the long-term survival and short-term outcomes.

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 Prognostic role of platelet to lymphocyte ratio in non-small cell lung cancers: A meta-analysis including 3,720 patients

2016 ◽  
Vol 139 (1) ◽  
pp. 164-170 ◽  
Author(s):  
Qing-Tao Zhao ◽  
Zheng Yuan ◽  
Hua Zhang ◽  
Xiao-Peng Zhang ◽  
Hui-En Wang ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Small Cell ◽  
Small Cell Lung ◽  
Prognostic Role ◽  
Platelet To Lymphocyte Ratio ◽  
Lung Cancers ◽  
Lymphocyte Ratio

scholarly journals Minimally invasive versus conventional surgery of the ascending aorta and root: a systematic review and meta-analysis

2019 ◽  
Vol 57 (1) ◽  
pp. 8-17 ◽  
Author(s):  
Tom A Rayner ◽  
Sean Harrison ◽  
Paul Rival ◽  
Dominic E Mahoney ◽  
Massimo Caputo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Impairment ◽  
Minimally Invasive ◽  
Risk Ratio ◽  
Observational Studies ◽  
Meta Analysis ◽  
Ascending Aorta ◽  
Mean Difference ◽  
Standardized Mean Difference

Summary Limited uptake of minimally invasive surgery (MIS) of the aorta hinders assessment of its efficacy compared to median sternotomy (MS). The objective of this systematic review is to compare operative and perioperative outcomes for MIS versus MS. Online databases Medline, EMBASE, Cochrane Library and Web of Science were searched from inception until July 2018. Both randomized and observational studies of patients undergoing aortic root, ascending aorta or aortic arch surgery by MIS versus MS were eligible for inclusion. Primary outcomes were 30-day mortality, reoperation for bleeding, perioperative renal impairment and neurological events. Intraoperative and postoperative timing measures were also evaluated. Thirteen observational studies were included comparing 1101 MIS and 1405 MS patients. The overall quality of evidence was very low for all outcomes. Mortality and the incidence of stroke were similar between the 2 cohorts. Meta-analysis demonstrated increased length of cardiopulmonary bypass (CPB) time for patients undergoing MS [standardized mean difference 0.36, 95% confidence interval (CI) 0.15–0.58; P = 0.001]. Patients receiving MS spent more time in hospital (standardized mean difference 0.30, 95% CI 0.17–0.43; P &lt; 0.001) and intensive care (standardized mean difference 0.17, 95% CI 0.06–0.27; P &lt; 0.001). Reoperation for bleeding (risk ratio 1.51, 95% CI 1.06–2.17; P = 0.024) and renal impairment (risk ratio 1.97, 95% CI 1.12–3.46; P = 0.019) were also greater for MS patients. There was substantial heterogeneity in meta-analyses for CPB and aortic cross-clamp timing outcomes. MIS may be associated with improved early clinical outcomes compared to MS, but the quality of the evidence is very low. Randomized evidence is needed to confirm these findings.

scholarly journals Three and Five-Year Mortality in Ovarian Cancer after Minimally Invasive Compared to Open Surgery: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 9 (8) ◽  
pp. 2507 ◽  
Author(s):  
Floriane Jochum ◽  
Muriel Vermel ◽  
Emilie Faller ◽  
Thomas Boisrame ◽  
Lise Lecointre ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Open Surgery ◽  
Meta Analysis ◽  
Perioperative Outcomes ◽  
Cochrane Library ◽  
Significant Difference ◽  
Advanced Stages

As regards ovarian cancer, the use of minimally invasive surgery has steadily increased over the years. Reluctance persists, however, about its oncological outcomes. The main objective of this meta-analysis was to compare the three and five-year mortality of patients operated by minimally invasive surgery (MIS) for ovarian cancer to those operated by conventional open surgery (OPS), as well as their respective perioperative outcomes. PubMed, Cochrane library and CinicalTrials.gov were systematically searched, using the terms laparoscopy, laparoscopic or minimally invasive in combination with ovarian cancer or ovarian carcinoma. We finally included 19 observational studies with a total of 7213 patients. We found no statistically significant difference for five-year (relative risk (RR) = 0.89, 95% CI 0.53–1.49, p = 0.62)) and three-year mortality (RR = 0.95, 95% CI 0.80–1.12, p = 0.52) between the patients undergoing MIS and those operated by OPS. When five and three-year recurrences were analyzed, no statistically significant differences were also observed. Analysis in early and advanced stages subgroups showed no significant difference for survival outcomes, suggesting oncological safety of MIS in all stages. Whether the surgery was primary or interval debulking surgery in advanced ovarian cancer, did not influence the comparative results on mortality or recurrence. Although the available studies are retrospective, and mostly carry a high risk for bias and confounding, an overwhelming consistency of the evidence suggests the likely effectiveness of MIS in selected cases of ovarian cancer, even in advanced stages. To validate the use of MIS, the development of future randomized interventional studies should be a priority.

scholarly journals Benefits of local consolidative treatment in oligometastases of solid cancers: a stepwise-hierarchical pooled analysis and systematic review

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Chai Hong Rim ◽  
In-Soo Shin ◽  
Sunmin Park ◽  
Hye Yoon Lee
Keyword(s):  
Observational Studies ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Small Cell ◽  
Cochrane Library ◽  
Small Cell Lung ◽  
Lung Cancers ◽  
Randomized Controlled ◽  
Grade 3 ◽  
Available Information

AbstractWe conducted a meta-analysis of articles published in PubMed, MEDLINE, EMBASE, and Cochrane library to investigate the effectiveness of local consolidative therapy (LCT) against oligometastases. Data from randomized controlled trials (RCTs), balanced studies, and all studies combined were analyzed in a hierarchical manner. Pooled analyses of 31 studies (including seven randomized trials) investigating the effectiveness of LCT on overall survival revealed odds ratios of 3.04, 2.56, and 1.41 for all studies, balanced studies, and RCTs, respectively (all p < 0.05). The benefit of LCT was more prominent in patients with non-small cell lung and colorectal cancers than in those with prostate and small cell lung cancers. Moreover, the benefit of LCT was smaller in patients with high metastatic burdens (p = 0.054). In four of 12 studies with available information, additional grade ≥3 toxicities due to LCTs were reported. Overall, LCT is beneficial for patients with oligometastases, although such benefits are less evident in RCTs than in observational studies. Appropriate LCTs should be carefully selected considering their feasibility, disease type, and metastatic burden.

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