Video-assisted thoracoscopic surgery lobectomy versus open lobectomy in patients with clinical stage I non-small cell lung cancer: A meta-analysis

Aims: Video-assisted thoracoscopic surgery (VATS) lobectomy for early lung cancer has been shown to be technically feasible. Weather VATS lobectomy has equivalent or better clinical effect compared with open lobectomy for early lung cancer patients remains controversial. The purpose is to assess the value of VATS compared with thoracotomy for stage I non-small cell lung cancer (NSCLC) by meta-analysis. Methods: We searched databases of EMBASE, PubMed, and ScienceDirect for relevant articles published between January 1990 and January 2013. Eligible studies were randomized controlled trials (RCTs) or comparative studies of VATS lobectomy and open lobectomy for clinical stage I NSCLC. Data on operation time, intra-operative blood loss, length of chest tube drainage and hospital stay, complications incidence and 5 year survival rate were meta-analyzed using Review Manager 5.0. Results: 20 studies with 3457 clinical stage I NSCLC patients were included. There was no difference in operation time between the two. groups (P = 0.14), but distinct advantages in terms of intra-operative blood loss, chest drainage time, hospital stay and complication incidence were found in the VATS group (P < 0.01). Moreover, the 5 year survival rate of VATS group was significantly higher than thoracotomy group (OR 1.82, 95% CI, 1.43-2.31, P < 0.01). Conclusion: Compared with thoracotomy group, VATS achieved better surgical and oncological outcomes and was a more favorable treatment for stage I NSCLC patients. (C) 2013 Elsevier Ltd. All rights reserved.