ObjectiveTo systematically evaluate of the difference in clinical outcomes between Da-Vinci robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) for mediastinal tumor resection. MethodsOnline databases including The Cochrane Library, PubMed, EMbase, Web of Science, SinoMed, CNKI, and Wanfang were searched by two researchers independently from inception to October 10, 2022. The quality of the included literature was evaluated using the Newcastle-Ottawa Scale (NOS). The meta-analysis was performed by RevMan 5.3. ResultsA total of 23 studies with 5 646 patients were enrolled in the final study. The NOS scores of the studies were≥6 points. The results of meta-analysis showed that compared with the VATS group, the blood loss was less [MD=−18.11, 95%CI (−26.12, −10.09), P＜0.001], time of postoperative drainage tube retention [MD=−0.79, 95%CI (−1.09, −0.49), P＜0.001] and postoperative hospitalization time [MD=−1.00, 95%CI (−1.36, −0.64), P＜0.001] were shorter, postoperative day 1 drainage [MD=−5.53, 95%CI (−9.94, −1.12), P=0.010] and total postoperative drainage [MD=−88.41, 95%CI (−140.85, −35.97), P=0.001] were less, the rates of postoperative complications [OR=0.66, 95%CI (0.46, 0.94), P=0.020] and conversion to thoracotomy [OR=0.32, 95%CI (0.19, 0.53), P＜0.001] were lower, and the hospitalization costs were higher [MD=2.60, 95%CI (1.40, 3.79), P＜0.001] in the RATS group. The operative time was not statistically different between the two groups [MD=5.94, 95%CI (−1.45, 13.34), P=0.120]. ConclusionRATS mediastinal tumor resection has a high safety profile. Compared with VATS, patients have less intraoperative blood loss, a lower rate of conversion to thoracotomy, and shorter postoperative tube time and hospital stay, which is more conducive to rapid postoperative recovery.
Objective To systematically evaluate the difference in clinical outcomes between subxiphoid video-assisted thoracoscopic surgery (SVATS) and intercostal video-assisted thoracoscopic surgery (IVATS) for anterior mediastinal tumor resection. Methods Online databases including The Cochrane Library, PubMed, EMbase, Web of Science, Sinomed, CNKI, Wanfang from inception to December 19, 2022 were searched by two researchers independently for literature comparing the clinical efficacy of SVATS and IVATS in treating anterior mediastinal tumors. Two researchers independently screened literature and extracted relevant data. The quality of the included literature was evaluated using the Newcastle-Ottawa Scale (NOS). The meta-analysis was performed by RevMan 5.3. ResultsA total of 12 studies with 1 517 patients were enrolled. NOS score≥6 points. The results of meta-analysis showed that compared with the IVATS, SVATS had less blood loss (MD=−17.76, 95%CI −34.21 to −1.31, P=0.030), less total postoperative drainage volume (MD=−70.46, 95%CI −118.88 to −22.03, P=0.004), shorter duration of postoperative drainage tube retention (MD=−0.84, 95%CI −1.57 to −0.10, P=0.030), lower rate of postoperative lung infections (OR=0.33, 95%CI 0.16 to 0.70, P=0.004), lower postoperative 24 h VAS pain score (MD=−1.95, 95%CI −2.64 to −1.25, P＜0.001) and 72 h VAS pain score (MD=−1.76, 95%CI −2.55 to −0.97, P＜0.001), and shorter postoperative hospital stay (MD=−1.12, 95%CI −1.80 to −0.45, P=0.001). There was no statistical difference in the operation time, the incidence of postoperative complications, incidence of postoperative phrenic nerve palsy or incidence of postoperative arrhythmia (P＞0.05). ConclusionSVATS for the treatment of anterior mediastinal tumors has high safety. Compared with the IVATS, the patients have less intraoperative blood loss and postoperative drainage volume, lower risk of postoperative pulmonary infection, less postoperative short-term pain, and shorter postoperative catheter duration and hospital stay, which is more conducive to rapid postoperative recovery.
ObjectiveTo systematically evaluate the clinical outcomes of minimally invasive lung segment resection and lobectomy resection for stageⅠA non-small cell lung cancer (NSCLC) in order to provide reference for clinical application. MethodsOnline databases including The Cochrane Library, PubMed, EMbase, Web of Science, SinoMed, CNKI, and Wanfang were searched from inception to January 21, 2023 by two researchers independently. The quality of the included literature was evaluated using the Newcastle-Ottawa Scale (NOS). The prognostic indicators included the overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS). The meta-analysis was performed using STATA 14.0. ResultsA total of 13 studies with 1 853 patients were enrolled in the final study, with NOS scores≥7 points. The results of meta-analysis showed that compared with the MILLR group, the blood loss was less [SMD=−0.36, 95%CI (−0.49, −0.23), P<0.001], postoperative drainage tube retention time [SMD=−0.34, 95%CI (−0.62, −0.05), P=0.019] and hospitalization time [SMD=−0.28, 95%CI (−0.40, −0.15), P<0.001] were shorter in the MILSR group. More lymph nodes [SMD=−0.65, 95%CI (−0.78, −0.53), P<0.001] and shorter operation time [SMD=0.20, 95%CI (0.07, 0.33), P=0.003] were found in the MILLR group. There were no statistical differences in the incidence of postoperative complications, postoperative recurrence rate, OS, DFS or RFS between the two groups. Conclusion Although the number of lymph nodes removed by MILSR is limited compared with MILLR, it does not affect the prognosis. MILSR has advantages in reducing intraoperative blood loss and shortening postoperative drainage tube retention time and hospital stay. For the surgical treatment of stageⅠA NSCLC, MILSR may be a more appropriate surgical approach.
Objective To compare the safety and efficacy of the subxiphoid robot-assisted thoracoscopic surgery (SRATS) and intercostal robot-assisted thoracoscopic surgery (IRATS) for the treatment of anterior mediastinal tumors. Methods The clinical data of patients who received robot-assisted anterior mediastinal tumor resection in the same medical unit of the Department of Thoracic Surgery of Gansu Provincial Hospital from May 2020 to July 2022 were retrospectively collected. The patients were divided into a SRATS group and an IRATS group according to the surgical procedure. The perioperative data of patients were compared between the two groups. Results Finally 87 patients were collected, including 41 in the SRATS group (23 males and 18 females, mean age of 44.51±11.28 years) and 46 in the IRATS group (21 males and 25 females, mean age of 46.67±8.76 years). All 87 patients completed the surgery successfully. Compared with IRATS group, SRATS group had less intraoperative blood loss (24.41±6.67 mL vs. 37.93±9.23 mL, P=0.000), shorter postoperative catheterization time (1.73±0.59 d vs. 2.54±0.50 d, P=0.000), less postoperative drainage (94.46±34.08 mL vs. 116.72±24.90 mL, P=0.001), lower visual analogue score (VAS) on the first postoperative day (3.66±0.76 points vs. 4.15±0.84 points, P=0.005) and third postoperative day (2.41±0.59 points vs. 2.89±0.82 points, P=0.003), shorter postoperative hospital stay (4.12±0.81 d vs. 4.98±1.02 d, P=0.000) and lower hospitalization costs (45.1±6.5 thousand yuan vs. 48.6±6.8 thousand yuan, P=0.020). There was no significant difference in the operation time or the incidence of postoperative complications. Conclusion Both SRATS and IRATS have high safety and efficacy in the treatment of anterior mediastinal tumors. However, SRATS has less damage, which is more conducive to the rapid recovery of patients after surgery, and has a wide prospect of clinical application.