Single- <i>versus</i> multiple-port thoracoscopic lobectomy in non-small cell lung cancer: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Hanjie , CHEN Guirong , HUANG Jun ,  HE Jiaxian

Department of Thoracic Surgery, the Wuzhou Red Cross Hospital, Wuzhou, 543002, Guangxi, P.R.China;

Corresponding author：

HE Jiaxian, Email: 563791044@qq.com

Keywords：

Video-assisted thoracoscopic surgery; non-small cell lung cancer; single-port; multiple-port; lobectomy; meta-analysis

DOI：

10.7507/1007-4848.201810042

Video：

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Objective To systematically review the efficacy and safety of single-port video-assisted thoracoscopic surgery (VATS) vs. multiple-port VATS in lobectomy for non-small cell lung cancer (NSCLC).Methods The PubMed, EMbase, the Cochrane Library, CBM, CNKI, Wanfang, VIP and Web of Science were searched to collect clinical studies about single- vs. multiple-port VATS for patients with NSCLC from inception to August 2018. The literatures were screened, data were extracted and the risk of bias of included studies was assessed independently by two reviewers. The meta-analysis with the collected data was performed by using RevMan 5.3 software.Results Eleven studies (4 randomized controlled trials, 1 prospective cohort study and 6 retrospective cohort studies), including 1 574 patients. Among them, 779 patients were in the single-port group, and 795 in the multiple-port group. The results of meta-analysis showed that there was no significant difference between the two groups in the operation time (MD=3.60, 95%CI –8.59 to 15.79, P=0.56), the conversion rate (OR=1.06, 95%CI 0.54 to 2.06, P=0.87), the incidence of postoperative complications (OR=0.76, 95%CI 0.53 to 1.10, P=0.15), postoperative hospitalization time (MD=0.74, 95%CI –1.60 to 0.12, P=0.09), chest tube placement time (MD=0.63, 95%CI –1.28 to 0.02, P=0.06) or harvested lymph nodes (MD=–0.11, 95%CI –0.46 to 0.24, P=0.54). The intraoperative blood loss (MD=–17.12, 95%CI –31.16 to –3.08, P=0.02) was less in the single-port group than that in the multiple-port group. The visual analogue score (VAS) on postoperative first day (MD=–1.30, 95%CI –1.85 to –0.75, P<0.000 01) and on postoperative third day (MD=–0.82, 95%CI –1.00 to –0.65, P<0.000 01) were lower in the single-port group than those in the multiple-port group.Conclusion The meta-analysis indicates that the efficacy of single-port VATS for NSCLC is equivalent to multiple-port VATS. However the intraoperative blood loss, the VAS scores on postoperative first and third days in the single-port group are better.

Citation： XU Hanjie, CHEN Guirong, HUANG Jun, HE Jiaxian. Single- versus multiple-port thoracoscopic lobectomy in non-small cell lung cancer: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(8): 789-794. doi: 10.7507/1007-4848.201810042 Copy

1.	Rafiemanesh H, Mehtarpour M, Khani F, et al. Epidemiology, incidence and mortality of lung cancer and their relationship with the development index in the world. J Thorac Dis, 2016, 8(6): 1094-1102.
2.	Hartwig MG, D'Amico TA. Thoracoscopic lobectomy: the gold standard for early-stage lung cancer? Ann Thorac Surg, 2010, 89(6): S2098-S2101.
3.	王继振, 刘公哲, 李大宏. 单孔全胸腔镜下肺叶切除治疗周围型非小细胞肺癌的安全性和有效性. 现代肿瘤医学, 2018, 26(10): 1544-1547.
4.	隆治泉. 单孔与多孔胸腔镜手术对Ⅰ期非小细胞肺癌的临床疗效比较. 临床医药文献电子杂志, 2018, 5(31): 78.
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6.	马洪飚, 黄伟, 罗锋, 等. 胸腔镜单操作孔法与单孔法行肺叶切除术治疗早期非小细胞肺癌的临床效果比较. 广西医学, 2017, 39(7): 971-973, 986.
7.	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.
8.	石岱旺, 徐然, 韩云, 等. 单孔与三孔胸腔镜肺叶切除术治疗周围型肺癌的临床疗效比较. 中国医科大学学报, 2018, 47(7): 609-611, 616.
9.	Song KS, Park CK, Kim JB. Efficacy of single-port video-assisted thoracoscopic surgery lobectomy compared with triple-port VATS by propensity score matching. Korean J Thorac Cardiovasc Surg, 2017, 50(5): 339-345.
10.	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.
11.	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.
12.	Son BS, Kim DH. Perioperative and mid-term outcomes after single port versus multi-ports thoracoscopic lobectomy for lung cancer: A propensity matching study. J Thorac Oncol, 2017, 1(Suppl 1): S757-S758.
13.	Han KN, Kim HK, Choi YH. Single-port versus multiport thoracoscopic lobectomy in non-small-cell lung cancer: Propensity-score matched analysis. Innovations (Phila), 2017, 12(Suppl 4): S125.
14.	Rocco G, Khalil M, Jutley R. Uniportal video-assisted thoracoscopic surgery wedge lung biopsy in the diagnosis of interstitial lung diseases. J Thorac Cardiovasc Surg, 2005, 129(4): 947-948.
15.	Gonzalez D, de la Torre M, Paradela M, et al. Video-assisted thoracic surgery lobectomy: 3-year initial experience with 200 cases. Eur J Cardiothorac Surg, 2011, 40(1): e21-e28.
16.	Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken), 2011, 63 (Suppl 11): S240-S252.
17.	Jensen MP, Karoly P, O'Riordan EF, et al. The subjective experience of acute pain. An assessment of the utility of 10 indices. Clin J Pain, 1989, 5(2): 153-159.
18.	West D, Young R, McElnay P, et al. Is uniport thoracoscopic surgery less painful than multiple port approaches? Interact Cardiovasc Thorac Surg, 2015, 20(3): 414.
19.	Doddoli C, Aragon A, Barlesi F, et al. Does the extent of lymph node dissection influence outcome in patients with stageⅠnon-small-cell lung cancer? Eur J Cardiothorac Surg, 2005, 27(4): 680-685.
20.	张皓, 齐海, 王磊, 等. 电视胸腔镜与开胸手术治疗非小细胞肺癌随机对照研究的系统评价和Meta分析. 中国胸心血管外科临床杂志, 2015, 22(12): 1087-1094.

1. Rafiemanesh H, Mehtarpour M, Khani F, et al. Epidemiology, incidence and mortality of lung cancer and their relationship with the development index in the world. J Thorac Dis, 2016, 8(6): 1094-1102.
2. Hartwig MG, D'Amico TA. Thoracoscopic lobectomy: the gold standard for early-stage lung cancer? Ann Thorac Surg, 2010, 89(6): S2098-S2101.
3. 王继振, 刘公哲, 李大宏. 单孔全胸腔镜下肺叶切除治疗周围型非小细胞肺癌的安全性和有效性. 现代肿瘤医学, 2018, 26(10): 1544-1547.
4. 隆治泉. 单孔与多孔胸腔镜手术对Ⅰ期非小细胞肺癌的临床疗效比较. 临床医药文献电子杂志, 2018, 5(31): 78.
5. 李志强, 宫心明, 韩孔启, 等. 单孔与三孔胸腔镜手术治疗早期非小细胞肺癌患者的疗效比较. 检验医学与临床, 2018, 15(6): 888-890.
6. 马洪飚, 黄伟, 罗锋, 等. 胸腔镜单操作孔法与单孔法行肺叶切除术治疗早期非小细胞肺癌的临床效果比较. 广西医学, 2017, 39(7): 971-973, 986.
7. 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.
8. 石岱旺, 徐然, 韩云, 等. 单孔与三孔胸腔镜肺叶切除术治疗周围型肺癌的临床疗效比较. 中国医科大学学报, 2018, 47(7): 609-611, 616.
9. Song KS, Park CK, Kim JB. Efficacy of single-port video-assisted thoracoscopic surgery lobectomy compared with triple-port VATS by propensity score matching. Korean J Thorac Cardiovasc Surg, 2017, 50(5): 339-345.
10. 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.
11. 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.
12. Son BS, Kim DH. Perioperative and mid-term outcomes after single port versus multi-ports thoracoscopic lobectomy for lung cancer: A propensity matching study. J Thorac Oncol, 2017, 1(Suppl 1): S757-S758.
13. Han KN, Kim HK, Choi YH. Single-port versus multiport thoracoscopic lobectomy in non-small-cell lung cancer: Propensity-score matched analysis. Innovations (Phila), 2017, 12(Suppl 4): S125.
14. Rocco G, Khalil M, Jutley R. Uniportal video-assisted thoracoscopic surgery wedge lung biopsy in the diagnosis of interstitial lung diseases. J Thorac Cardiovasc Surg, 2005, 129(4): 947-948.
15. Gonzalez D, de la Torre M, Paradela M, et al. Video-assisted thoracic surgery lobectomy: 3-year initial experience with 200 cases. Eur J Cardiothorac Surg, 2011, 40(1): e21-e28.
16. Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken), 2011, 63 (Suppl 11): S240-S252.
17. Jensen MP, Karoly P, O'Riordan EF, et al. The subjective experience of acute pain. An assessment of the utility of 10 indices. Clin J Pain, 1989, 5(2): 153-159.
18. West D, Young R, McElnay P, et al. Is uniport thoracoscopic surgery less painful than multiple port approaches? Interact Cardiovasc Thorac Surg, 2015, 20(3): 414.
19. Doddoli C, Aragon A, Barlesi F, et al. Does the extent of lymph node dissection influence outcome in patients with stageⅠnon-small-cell lung cancer? Eur J Cardiothorac Surg, 2005, 27(4): 680-685.
20. 张皓, 齐海, 王磊, 等. 电视胸腔镜与开胸手术治疗非小细胞肺癌随机对照研究的系统评价和Meta分析. 中国胸心血管外科临床杂志, 2015, 22(12): 1087-1094.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Single- versus multiple-port thoracoscopic lobectomy in non-small cell lung cancer: A systematic review and meta-analysis

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