Effectiveness and safety of single-incision <i>versus</i> conventional multiple ports video-assisted thoracic surgery in the treatment of lung cancer: A systematic review and meta-analysis _Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Yi ¹ ,  LIU Lunxu ²

1. West China School of Medicine/West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

LIU Lunxu, Email: lunxu_liu@aliyun.com

Keywords：

Systematic review/meta-analysis; single-incision video-assisted thoracic surgery; multiple ports video-assisted thoracic surgery; lung cancer

DOI：

10.7507/1007-4848.201705056

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Objective To evaluate the effectiveness and safety of single-incision video-assisted thoracic surgery versus conventional multiple ports video-assisted thoracic surgery in the treatment of lung cancer as well as providing reference for clinical decision-making. Methods We searched the Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP, Wanfang ect until March 2017 to collect randomized controlled trials (RCTs), cohort studies, and case-control studies comparing single-incision with conventional multiple ports video-assisted thoracic surgery for lung cancer.Two reviewers independently screened and selected literatures according to inclusion and exclusion criteria. Then data extraction and quality assessment of included studies were conducted. RevMan 5.3 software was used for meta-analysis. Results Twenty-six cohort studies (3 053 patients) were included. The quality of the included studies was high with score more than five.Meta-analysis showed that single-incision video-assisted thoracic surgery had shorter thoracic drainage time (MD=–0.71, 95% CI –1.03 to –0.39), shorter hospitalization time (MD=–0.92, 95% CI –1.66 to –0.19), lower pain scores 1 day after surgery (MD=–0.65, 95% CI –0.90 to –0.40), lower pain scores 3 days after surgery (MD=–0.90, 95% CI –1.16 to –0.64), lower pain scores 7 days after surgery (MD=–1.24, 95% CI –1.90 to –0.57), less number of lymph node dissection (MD=–0.72, 95% CI –1.35 to –0.10), less total drainage fluid (MD=–108.60, 95% CI –180.42 to –36.79) and shorter length of surgical incision (MD=–2.74, 95% CI –3.57 to –1.90) than conventional multiple ports video-assisted thoracic surgery. But the differences between the two groups in operation time, intraoperative blood loss, postoperative complications were not statistically significant. Conclusion Single-incision video-assisted thoracic surgery is safer and better in patient's compliance than conventional multiple ports video-assisted thoracic surgery in the treatment of lung cancer. But there is no significant difference in operation time, intraoperative blood loss, or postoperative complications. It still needs large-scale, high-quality studies to demonstrate its effectiveness and safety.

Citation： YANG Yi, LIU Lunxu. Effectiveness and safety of single-incision versus conventional multiple ports video-assisted thoracic surgery in the treatment of lung cancer: A systematic review and meta-analysis . Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(3): 222-232. doi: 10.7507/1007-4848.201705056 Copy

1.	陈万青, 张思维, 曾红梅, 等. 中国 2010 年恶性肿瘤发病与死亡. 中国肿瘤, 2014, 23(1): 1-10.
2.	支修益, 石远凯, 于金明. 中国原发性肺癌诊疗规范 (2015 年版). 中华肿瘤杂志, 2015, 37(1): 67-78.
3.	张艳娇, 高禹舜. 胸腔镜手术治疗肺癌的现状及趋势. 肿瘤学杂志, 2014, 20(10): 800-805.
4.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5. 0.2.The Cochrane Collaboration 2009[2009-09] .
5.	Wells G, Shea B, O'Connell D, et al. The New Castle-Ottawa Quality Assessment Scale-Cohort Studies.[2012-06-15] .
6.	朱启航, 肖海平, 何哲, 等. 3 种电视胸腔镜下手术治疗非小细胞肺癌早期创伤反应的比较. 实用医学杂志, 2016, 32(2): 231-235.
7.	连爱民, 师智勇, 万强辉, 等. 单操作孔胸腔镜肺癌根治术的临床应用分析. 中国现代医生, 2016, 54(20): 41-43.
8.	田承南, 唐志贤, 谢春发. 单操作孔胸腔镜治疗早期非小细胞肺癌手术对比分析. 赣南医学院学报, 2016, 36(3): 380-383.
9.	李金勇, 侯广杰. 单操作孔与传统三孔胸腔镜治疗早期非小细胞肺癌的对比研究. 河南外科学杂志, 2016, 22(3): 27-28.
10.	王赓学. 单孔法全胸腔镜肺段切除及淋巴结清扫术治疗 ⅠA 期周围型非小细胞肺癌 (NSCLC) 的临床分析. 世界最新医学信息文摘, 2016, (55): 81-82.
11.	周珉, 朱海宏. 单孔和三孔胸腔镜行肺癌根治术的临床效果对比研究. 浙江创伤外科, 2016, 21(4): 660-661.
12.	尹逊亮, 周勇安, 赵宁, 等. 单孔及多孔法胸腔镜手术治疗周围型非小细胞肺癌临床疗效的病例对照研究. 中国胸心血管外科临床杂志, 2016, 23(11): 1044-1049.
13.	王希文, 赵俊刚. 单孔胸腔镜肺癌根治术与传统三孔手术的对比分析. 重庆医学, 2016, 45(28): 3959-3961, 3964.
14.	肖鹏, 张晓. 单孔胸腔镜肺叶切除术与三孔胸腔镜肺叶切除术治疗肺癌的临床疗效对照. 中国实用医药, 2016, 11(29): 60-61.
15.	王盛超, 张国俊, 贾明选, 等. 单孔与三孔腔镜肺叶切除淋巴结清扫治疗肺癌的比较. 现代肿瘤医学, 2017, 25(8): 1245-1249.
16.	郝志鹏, 蔡奕欣, 付圣灵, 等. 单孔与三孔胸腔镜肺癌根治术对患者术后疼痛及短期生活质量的对比研究. 中国肺癌杂志, 2016, 19(3): 122-128.
17.	张展飞, 梁柱, 陈铭扬, 等. 单孔与三孔胸腔镜肺癌根治术对术后疼痛的影响. 广东医学院学报, 2016, 34(6): 641-643.
18.	晋云鹏, 卢喜科, 张逊, 等. 单孔与三孔胸腔镜肺叶切除术的临床疗效对比. 天津医药, 2016, 44(1): 101-104.
19.	焦鹏, 李简, 佟宏峰, 等. 近距离两孔与单孔胸腔镜下肺癌手术的对比. 实用医学杂志, 2016, 32(10): 1627-1630.
20.	陈科. 单孔胸腔镜下肺叶切除术治疗周围型肺癌的手术流程及临床研究. 苏州大学. 2016. 1-41.
21.	韦海涛, 李丽, 王作培, 等. 单孔与三孔胸腔镜下肺癌根治术临床疗效的对比分析. 中华胸心血管外科杂志, 2016, 32(6): 356-358.
22.	Shih CS, Liu CC, Liu ZY, et al. Comparing the postoperative outcomes of video-assisted thoracoscopic surgery (VATS) segmentectomy using a multi-port technique versus a single-port technique for primary lung cancer. J Thorac Dis, 2016, 8(Suppl 3): S287-S294.
23.	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 Suppl 1: i48-i53.
24.	Dai F, Meng S, Mei L, et al. Single-port video-assisted thoracic surgery in the treatment of non-small cell lung cancer: a propensity-matched comparative analysis. J Thorac Dis, 2016, 8(10): 2872-2878.
25.	Lin F, Zhang C, Zhang Q, et al. Uniportal video-assisted thoracoscopic lobectomy: An alternative surgical method for pulmonary carcinoma. Pak J Med Sci, 2016, 32(5): 1283-1285.
26.	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.
27.	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(Suppl 1): i37-i41.
28.	叶辰阳, 柴莹. 单孔与多孔胸腔镜下肺叶切除术围手术期情况的对比. 浙江大学, 2015. 1-20.
29.	谢锦宝, 陈椿. 单孔胸腔镜与三孔胸腔镜行肺癌根治术的临床对比研究. 福建医科大学, 2015. 1-30.
30.	张海, 刘继先. 单孔与三孔法电视胸腔镜治疗原发性肺癌效果比较. 汕头大学, 2015. 1-31.
31.	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(Suppl 1): i64-i72.
32.	Swanson SJ, Herndon JE 2nd, 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.
33.	Cao C, Manganas C, Ang SC, et al. Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: a meta-analysis of propensity score-matched patients. Interact Cardiovasc Thorac Surg, 2013, 16(3): 244-249.
34.	Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
35.	Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol, 2009, 27(15): 2553-2562.
36.	Ceppa DP, Kosinski AS, Berry MF, et al. Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis. Ann Surg, 2012, 256(3): 487-493.

1. 陈万青, 张思维, 曾红梅, 等. 中国 2010 年恶性肿瘤发病与死亡. 中国肿瘤, 2014, 23(1): 1-10.
2. 支修益, 石远凯, 于金明. 中国原发性肺癌诊疗规范 (2015 年版). 中华肿瘤杂志, 2015, 37(1): 67-78.
3. 张艳娇, 高禹舜. 胸腔镜手术治疗肺癌的现状及趋势. 肿瘤学杂志, 2014, 20(10): 800-805.
4. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5. 0.2.The Cochrane Collaboration 2009[2009-09] .
5. Wells G, Shea B, O'Connell D, et al. The New Castle-Ottawa Quality Assessment Scale-Cohort Studies.[2012-06-15] .
6. 朱启航, 肖海平, 何哲, 等. 3 种电视胸腔镜下手术治疗非小细胞肺癌早期创伤反应的比较. 实用医学杂志, 2016, 32(2): 231-235.
7. 连爱民, 师智勇, 万强辉, 等. 单操作孔胸腔镜肺癌根治术的临床应用分析. 中国现代医生, 2016, 54(20): 41-43.
8. 田承南, 唐志贤, 谢春发. 单操作孔胸腔镜治疗早期非小细胞肺癌手术对比分析. 赣南医学院学报, 2016, 36(3): 380-383.
9. 李金勇, 侯广杰. 单操作孔与传统三孔胸腔镜治疗早期非小细胞肺癌的对比研究. 河南外科学杂志, 2016, 22(3): 27-28.
10. 王赓学. 单孔法全胸腔镜肺段切除及淋巴结清扫术治疗 ⅠA 期周围型非小细胞肺癌 (NSCLC) 的临床分析. 世界最新医学信息文摘, 2016, (55): 81-82.
11. 周珉, 朱海宏. 单孔和三孔胸腔镜行肺癌根治术的临床效果对比研究. 浙江创伤外科, 2016, 21(4): 660-661.
12. 尹逊亮, 周勇安, 赵宁, 等. 单孔及多孔法胸腔镜手术治疗周围型非小细胞肺癌临床疗效的病例对照研究. 中国胸心血管外科临床杂志, 2016, 23(11): 1044-1049.
13. 王希文, 赵俊刚. 单孔胸腔镜肺癌根治术与传统三孔手术的对比分析. 重庆医学, 2016, 45(28): 3959-3961, 3964.
14. 肖鹏, 张晓. 单孔胸腔镜肺叶切除术与三孔胸腔镜肺叶切除术治疗肺癌的临床疗效对照. 中国实用医药, 2016, 11(29): 60-61.
15. 王盛超, 张国俊, 贾明选, 等. 单孔与三孔腔镜肺叶切除淋巴结清扫治疗肺癌的比较. 现代肿瘤医学, 2017, 25(8): 1245-1249.
16. 郝志鹏, 蔡奕欣, 付圣灵, 等. 单孔与三孔胸腔镜肺癌根治术对患者术后疼痛及短期生活质量的对比研究. 中国肺癌杂志, 2016, 19(3): 122-128.
17. 张展飞, 梁柱, 陈铭扬, 等. 单孔与三孔胸腔镜肺癌根治术对术后疼痛的影响. 广东医学院学报, 2016, 34(6): 641-643.
18. 晋云鹏, 卢喜科, 张逊, 等. 单孔与三孔胸腔镜肺叶切除术的临床疗效对比. 天津医药, 2016, 44(1): 101-104.
19. 焦鹏, 李简, 佟宏峰, 等. 近距离两孔与单孔胸腔镜下肺癌手术的对比. 实用医学杂志, 2016, 32(10): 1627-1630.
20. 陈科. 单孔胸腔镜下肺叶切除术治疗周围型肺癌的手术流程及临床研究. 苏州大学. 2016. 1-41.
21. 韦海涛, 李丽, 王作培, 等. 单孔与三孔胸腔镜下肺癌根治术临床疗效的对比分析. 中华胸心血管外科杂志, 2016, 32(6): 356-358.
22. Shih CS, Liu CC, Liu ZY, et al. Comparing the postoperative outcomes of video-assisted thoracoscopic surgery (VATS) segmentectomy using a multi-port technique versus a single-port technique for primary lung cancer. J Thorac Dis, 2016, 8(Suppl 3): S287-S294.
23. 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 Suppl 1: i48-i53.
24. Dai F, Meng S, Mei L, et al. Single-port video-assisted thoracic surgery in the treatment of non-small cell lung cancer: a propensity-matched comparative analysis. J Thorac Dis, 2016, 8(10): 2872-2878.
25. Lin F, Zhang C, Zhang Q, et al. Uniportal video-assisted thoracoscopic lobectomy: An alternative surgical method for pulmonary carcinoma. Pak J Med Sci, 2016, 32(5): 1283-1285.
26. 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.
27. 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(Suppl 1): i37-i41.
28. 叶辰阳, 柴莹. 单孔与多孔胸腔镜下肺叶切除术围手术期情况的对比. 浙江大学, 2015. 1-20.
29. 谢锦宝, 陈椿. 单孔胸腔镜与三孔胸腔镜行肺癌根治术的临床对比研究. 福建医科大学, 2015. 1-30.
30. 张海, 刘继先. 单孔与三孔法电视胸腔镜治疗原发性肺癌效果比较. 汕头大学, 2015. 1-31.
31. 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(Suppl 1): i64-i72.
32. Swanson SJ, Herndon JE 2nd, 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.
33. Cao C, Manganas C, Ang SC, et al. Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: a meta-analysis of propensity score-matched patients. Interact Cardiovasc Thorac Surg, 2013, 16(3): 244-249.
34. Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
35. Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol, 2009, 27(15): 2553-2562.
36. Ceppa DP, Kosinski AS, Berry MF, et al. Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis. Ann Surg, 2012, 256(3): 487-493.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effectiveness and safety of single-incision versus conventional multiple ports video-assisted thoracic surgery in the treatment of lung cancer: A systematic review and meta-analysis

Abstract Full text Figures/Tables Video References Cited by

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