Effectiveness of Thoracoscopy Surgery versus Thoracotomy for Thymoma: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LIShuang ¹ , WANGLi-wei ¹ , HUWen-teng ¹ , LINRui-jiang ¹ , MAMin-jie ² ,  HANBiao ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China;
2. Department of Thoracic Surgery, the First Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

HANBiao, Email: hanbiao66@msn.com

Keywords：

Thymoma; Thoracoscopy surgery; Thoracotomy; Systematic review; Meta-analysis; Randomized controlled trial; Cohort study

DOI：

10.7507/1672-2531.20160107

Video：

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Objective To systematically review the effectiveness of thoracoscopy surgery and thoracotomy for thymoma. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2016), Web of Science, CBM, WanFang Data and CNKI were searched to collect randomized controlled trials (RCTs) and cohort studies about thoracoscopy surgery versus thoracotomy for thymoma from inception to April 2016. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 5 RCTs and 8 cohort studies involving 1 093 patients were included. The results of meta-analysis showed that, compared with thoracotomy, the thoracoscopy surgery could shorten operative time (MD= –22.2, 95%CI –32.92 to –12.52, P < 0.000 01), duration of ICU stay (MD= –0.76, 95%CI –0.21 to –0.30, P < 0.000 01), duration of hospital stay (MD= –3.71, 95%CI –4.47 to –2.96, P < 0.000 01) and duration of pleural drainage (MD= –1.80, 95%CI –2.42 to –1.18, P < 0.000 01), reduce volume of intraoperative blood loss (MD= –43.27, 95%CI –50.94 to –35.60, P < 0.000 01), and decrease the incidence of postoperative complications (OR=0.19, 95%CI 0.11 to 0.34, P < 0.000 01), but there was no significant difference in recurrence rate between two groups (OR=0.81, 95%CI 0.31 to 2.11, P=0.67). Conclusions Current evidence shows that, compared with thoracotomy, the thoracoscopy surgery for thymoma has shorter operative time, duration of ICU stay, duration of hospital stay, and duration of pleural drainage, as well as less blood loss and postoperative complications. Due to the limited quality of included studies, more high-quality studies are needed to verify the above conclusion.

Citation： LIShuang, WANGLi-wei, HUWen-teng, LINRui-jiang, MAMin-jie, HANBiao. Effectiveness of Thoracoscopy Surgery versus Thoracotomy for Thymoma: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(6): 689-697. doi: 10.7507/1672-2531.20160107 Copy

1.	Engels EA, Pfeiffer RM. Malignant thymoma in the United States: demographic patterns in incidence and associations with subsequent malignancies. Int J Cancer, 2003, 105(4): 546-551.
2.	Takeo S, Tsukamoto S, Kawano D, et al. Outcome of an original video-assisted thoracoscopic extended thymectomy for thymoma. Ann Thorac Surg, 2011, 92(6): 2000-2005.
3.	Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg, 2003, 76(3): 878-884.
4.	Venutav F, Azienda P. Thymoma and thymiccarcinoma. Eur J CardioThorac Surg, 2010, 37(1): 13-25.
5.	Lucchi M, Ricciardi R, Melfi F, et al. Association of thymoma and myasthenia gravis: oncological and neurological results of the surgical treatment. Eur J Cardiothorac Surg, 2009, 35(5): 812-816.
6.	魏德胜. 微创手术在胸腺瘤并重症肌无力外科治疗中的应用. 中华全科医学, 2013, 11(9): 1383-1385.
7.	Gu ZT, Mao T, Chen WH, et al. Comparison of videoassisted thoracoscopic surgery and median sternotomy approaches for thymic tumor resections at a single institution. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): 47-51.
8.	Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at: http://handbook.cochrane.org.
9.	俞晖. 电视胸腔镜下手术治疗胸腺瘤与传统手术治疗的临床对比研究. 临床和实验医学杂志, 2014, 13(19): 1615-1618.
10.	李富, 李标. 胸腔镜与开胸手术治疗重症肌无力合并胸腺瘤疗效对于分析. 河北医药, 2014, 36(20): 3088-3089.
11.	文石兵, 胡定中, 何林峰. 微创手术治疗老年胸腺瘤的临床分析. 中华全科医学, 2013, 11(11): 1707-1708.
12.	齐瑞. 胸腔镜与开胸手术治疗重症肌无力合并胸腺瘤的随机对照研究. 中国医学工程, 2015, 23(9): 79-81.
13.	任自学, 王圣应, 张荣新. 电视胸腔镜手术与传统手术治疗胸腺瘤疗效比较. 新乡医学院学报, 2014, 31(7): 544-545.
14.	罗国军, 庄江能, 李卓东, 等. 胸腺瘤不同外科手术方式的临床对比研究. 中华全科医学, 2 012, 10(4): 531-532.
15.	Imthiaz M, Robert N, Rahul S, et al. Early and mid-term outcomes of trans-sternal and video-assisted thoracoscopic surgery for thymoma. Eur J Cardiothorac Surg, 2014, 45(6): 187-193.
16.	Makoto O, Tadashi A, Mitsuo Y, et al. Unilateral thoracoscopic subtotal thymectomy for the treatment of stage I and II thymoma. Eur J Cardiothorac Surg, 2010, 37(4): 824-826.
17.	Tom J, Mong WL, Min SH, et al. Video-assisted thoracoscopic surgical thymectomy to treat early thymoma: a comparison with the conventional transsternal approach. Ann Surg Oncol, 2014, 21(1): 322-328.
18.	Tsutomu T, Naoya Y, Tomoshi T, et al. Thoracoscopic versus transsternal resection for early stage thymoma: long-term outcomes. Surg Today, 2014, 44(12): 2275-2280.
19.	Zhicheng H, Quan Z, Wei W, et al. Surgical approaches for stage I and II thymoma-associated myasthenia gravis: feasibility of complete video-assisted thoracoscopic surgery (VATS) thymectomy in comparison with trans-sternal resection. The Journal of Biomedical Research, 2013, 27(1): 62-70.
20.	Zhitao G, Teng M, Wenhu Ch, et al. Comparison of video-assisted thoracoscopic surgery and median sternotomy approaches for thymic tumor resections at a single institution. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): 47-51.
21.	Arjun P, Irfan Q, Matthew JS, et al. Comparison of surgical techniques for early-stage thymoma: Feasibility of minimally invasive thymectomy and comparison with open resection. General Thoracic Surgery, 2011, 141(3): 694-701.
22.	Adam JF, Elizabeth AH, Stacey S, et al. Minimally invasive versus open thymectomy for thymic malignancies: systematic review and meta-analysis. J Thorac Oncol, 2015, 11(1): 30-38.
23.	Venuta F, Rendina EA, Longo F, et al. Long-term outcome after multimodality treatment for stage III thymic tumors. Ann Thorac Surg, 2003, 76(6): 1866-1872.
24.	Okumura M, Ohta M, Tateyama H, et al. The World Health Organization histologic classification system reflects the oncologic behavior of: a clinical study of 273 patients. Cancer. 2002, 94(3): 624-632.
25.	Bo Y, Ji-Cheng T, Xiao-Xiao G, et al. Surgical techniques for early-stage thymoma: Video-assisted thoracoscopic thymectomy versus transsternal thymectomy. J Thorac Cardiovasc Surg, 2014, 147(5): 1599-1603.

1. Engels EA, Pfeiffer RM. Malignant thymoma in the United States: demographic patterns in incidence and associations with subsequent malignancies. Int J Cancer, 2003, 105(4): 546-551.
2. Takeo S, Tsukamoto S, Kawano D, et al. Outcome of an original video-assisted thoracoscopic extended thymectomy for thymoma. Ann Thorac Surg, 2011, 92(6): 2000-2005.
3. Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg, 2003, 76(3): 878-884.
4. Venutav F, Azienda P. Thymoma and thymiccarcinoma. Eur J CardioThorac Surg, 2010, 37(1): 13-25.
5. Lucchi M, Ricciardi R, Melfi F, et al. Association of thymoma and myasthenia gravis: oncological and neurological results of the surgical treatment. Eur J Cardiothorac Surg, 2009, 35(5): 812-816.
6. 魏德胜. 微创手术在胸腺瘤并重症肌无力外科治疗中的应用. 中华全科医学, 2013, 11(9): 1383-1385.
7. Gu ZT, Mao T, Chen WH, et al. Comparison of videoassisted thoracoscopic surgery and median sternotomy approaches for thymic tumor resections at a single institution. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): 47-51.
8. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at: http://handbook.cochrane.org.
9. 俞晖. 电视胸腔镜下手术治疗胸腺瘤与传统手术治疗的临床对比研究. 临床和实验医学杂志, 2014, 13(19): 1615-1618.
10. 李富, 李标. 胸腔镜与开胸手术治疗重症肌无力合并胸腺瘤疗效对于分析. 河北医药, 2014, 36(20): 3088-3089.
11. 文石兵, 胡定中, 何林峰. 微创手术治疗老年胸腺瘤的临床分析. 中华全科医学, 2013, 11(11): 1707-1708.
12. 齐瑞. 胸腔镜与开胸手术治疗重症肌无力合并胸腺瘤的随机对照研究. 中国医学工程, 2015, 23(9): 79-81.
13. 任自学, 王圣应, 张荣新. 电视胸腔镜手术与传统手术治疗胸腺瘤疗效比较. 新乡医学院学报, 2014, 31(7): 544-545.
14. 罗国军, 庄江能, 李卓东, 等. 胸腺瘤不同外科手术方式的临床对比研究. 中华全科医学, 2 012, 10(4): 531-532.
15. Imthiaz M, Robert N, Rahul S, et al. Early and mid-term outcomes of trans-sternal and video-assisted thoracoscopic surgery for thymoma. Eur J Cardiothorac Surg, 2014, 45(6): 187-193.
16. Makoto O, Tadashi A, Mitsuo Y, et al. Unilateral thoracoscopic subtotal thymectomy for the treatment of stage I and II thymoma. Eur J Cardiothorac Surg, 2010, 37(4): 824-826.
17. Tom J, Mong WL, Min SH, et al. Video-assisted thoracoscopic surgical thymectomy to treat early thymoma: a comparison with the conventional transsternal approach. Ann Surg Oncol, 2014, 21(1): 322-328.
18. Tsutomu T, Naoya Y, Tomoshi T, et al. Thoracoscopic versus transsternal resection for early stage thymoma: long-term outcomes. Surg Today, 2014, 44(12): 2275-2280.
19. Zhicheng H, Quan Z, Wei W, et al. Surgical approaches for stage I and II thymoma-associated myasthenia gravis: feasibility of complete video-assisted thoracoscopic surgery (VATS) thymectomy in comparison with trans-sternal resection. The Journal of Biomedical Research, 2013, 27(1): 62-70.
20. Zhitao G, Teng M, Wenhu Ch, et al. Comparison of video-assisted thoracoscopic surgery and median sternotomy approaches for thymic tumor resections at a single institution. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): 47-51.
21. Arjun P, Irfan Q, Matthew JS, et al. Comparison of surgical techniques for early-stage thymoma: Feasibility of minimally invasive thymectomy and comparison with open resection. General Thoracic Surgery, 2011, 141(3): 694-701.
22. Adam JF, Elizabeth AH, Stacey S, et al. Minimally invasive versus open thymectomy for thymic malignancies: systematic review and meta-analysis. J Thorac Oncol, 2015, 11(1): 30-38.
23. Venuta F, Rendina EA, Longo F, et al. Long-term outcome after multimodality treatment for stage III thymic tumors. Ann Thorac Surg, 2003, 76(6): 1866-1872.
24. Okumura M, Ohta M, Tateyama H, et al. The World Health Organization histologic classification system reflects the oncologic behavior of: a clinical study of 273 patients. Cancer. 2002, 94(3): 624-632.
25. Bo Y, Ji-Cheng T, Xiao-Xiao G, et al. Surgical techniques for early-stage thymoma: Video-assisted thoracoscopic thymectomy versus transsternal thymectomy. J Thorac Cardiovasc Surg, 2014, 147(5): 1599-1603.

Chinese Journal of Evidence-Based Medicine

Effectiveness of Thoracoscopy Surgery versus Thoracotomy for Thymoma: A Meta-analysis

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