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.	陳萬青, 張思維, 曾紅梅, 等. 中國 2010 年惡性腫瘤發病與死亡. 中國腫瘤, 2014, 23(1): 1-10.
2.	支修益, 石遠凱, 于金明. 中國原發性肺癌診療規范 (2015 年版). 中華腫瘤雜志, 2015, 37(1): 67-78.
3.	張艷嬌, 高禹舜. 胸腔鏡手術治療肺癌的現狀及趨勢. 腫瘤學雜志, 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.	朱啟航, 肖海平, 何哲, 等. 3 種電視胸腔鏡下手術治療非小細胞肺癌早期創傷反應的比較. 實用醫學雜志, 2016, 32(2): 231-235.
7.	連愛民, 師智勇, 萬強輝, 等. 單操作孔胸腔鏡肺癌根治術的臨床應用分析. 中國現代醫生, 2016, 54(20): 41-43.
8.	田承南, 唐志賢, 謝春發. 單操作孔胸腔鏡治療早期非小細胞肺癌手術對比分析. 贛南醫學院學報, 2016, 36(3): 380-383.
9.	李金勇, 侯廣杰. 單操作孔與傳統三孔胸腔鏡治療早期非小細胞肺癌的對比研究. 河南外科學雜志, 2016, 22(3): 27-28.
10.	王賡學. 單孔法全胸腔鏡肺段切除及淋巴結清掃術治療 ⅠA 期周圍型非小細胞肺癌 (NSCLC) 的臨床分析. 世界最新醫學信息文摘, 2016, (55): 81-82.
11.	周珉, 朱海宏. 單孔和三孔胸腔鏡行肺癌根治術的臨床效果對比研究. 浙江創傷外科, 2016, 21(4): 660-661.
12.	尹遜亮, 周勇安, 趙寧, 等. 單孔及多孔法胸腔鏡手術治療周圍型非小細胞肺癌臨床療效的病例對照研究. 中國胸心血管外科臨床雜志, 2016, 23(11): 1044-1049.
13.	王希文, 趙俊剛. 單孔胸腔鏡肺癌根治術與傳統三孔手術的對比分析. 重慶醫學, 2016, 45(28): 3959-3961, 3964.
14.	肖鵬, 張曉. 單孔胸腔鏡肺葉切除術與三孔胸腔鏡肺葉切除術治療肺癌的臨床療效對照. 中國實用醫藥, 2016, 11(29): 60-61.
15.	王盛超, 張國俊, 賈明選, 等. 單孔與三孔腔鏡肺葉切除淋巴結清掃治療肺癌的比較. 現代腫瘤醫學, 2017, 25(8): 1245-1249.
16.	郝志鵬, 蔡奕欣, 付圣靈, 等. 單孔與三孔胸腔鏡肺癌根治術對患者術后疼痛及短期生活質量的對比研究. 中國肺癌雜志, 2016, 19(3): 122-128.
17.	張展飛, 梁柱, 陳銘揚, 等. 單孔與三孔胸腔鏡肺癌根治術對術后疼痛的影響. 廣東醫學院學報, 2016, 34(6): 641-643.
18.	晉云鵬, 盧喜科, 張遜, 等. 單孔與三孔胸腔鏡肺葉切除術的臨床療效對比. 天津醫藥, 2016, 44(1): 101-104.
19.	焦鵬, 李簡, 佟宏峰, 等. 近距離兩孔與單孔胸腔鏡下肺癌手術的對比. 實用醫學雜志, 2016, 32(10): 1627-1630.
20.	陳科. 單孔胸腔鏡下肺葉切除術治療周圍型肺癌的手術流程及臨床研究. 蘇州大學. 2016. 1-41.
21.	韋海濤, 李麗, 王作培, 等. 單孔與三孔胸腔鏡下肺癌根治術臨床療效的對比分析. 中華胸心血管外科雜志, 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.	葉辰陽, 柴瑩. 單孔與多孔胸腔鏡下肺葉切除術圍手術期情況的對比. 浙江大學, 2015. 1-20.
29.	謝錦寶, 陳椿. 單孔胸腔鏡與三孔胸腔鏡行肺癌根治術的臨床對比研究. 福建醫科大學, 2015. 1-30.
30.	張海, 劉繼先. 單孔與三孔法電視胸腔鏡治療原發性肺癌效果比較. 汕頭大學, 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. 陳萬青, 張思維, 曾紅梅, 等. 中國 2010 年惡性腫瘤發病與死亡. 中國腫瘤, 2014, 23(1): 1-10.
2. 支修益, 石遠凱, 于金明. 中國原發性肺癌診療規范 (2015 年版). 中華腫瘤雜志, 2015, 37(1): 67-78.
3. 張艷嬌, 高禹舜. 胸腔鏡手術治療肺癌的現狀及趨勢. 腫瘤學雜志, 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. 朱啟航, 肖海平, 何哲, 等. 3 種電視胸腔鏡下手術治療非小細胞肺癌早期創傷反應的比較. 實用醫學雜志, 2016, 32(2): 231-235.
7. 連愛民, 師智勇, 萬強輝, 等. 單操作孔胸腔鏡肺癌根治術的臨床應用分析. 中國現代醫生, 2016, 54(20): 41-43.
8. 田承南, 唐志賢, 謝春發. 單操作孔胸腔鏡治療早期非小細胞肺癌手術對比分析. 贛南醫學院學報, 2016, 36(3): 380-383.
9. 李金勇, 侯廣杰. 單操作孔與傳統三孔胸腔鏡治療早期非小細胞肺癌的對比研究. 河南外科學雜志, 2016, 22(3): 27-28.
10. 王賡學. 單孔法全胸腔鏡肺段切除及淋巴結清掃術治療 ⅠA 期周圍型非小細胞肺癌 (NSCLC) 的臨床分析. 世界最新醫學信息文摘, 2016, (55): 81-82.
11. 周珉, 朱海宏. 單孔和三孔胸腔鏡行肺癌根治術的臨床效果對比研究. 浙江創傷外科, 2016, 21(4): 660-661.
12. 尹遜亮, 周勇安, 趙寧, 等. 單孔及多孔法胸腔鏡手術治療周圍型非小細胞肺癌臨床療效的病例對照研究. 中國胸心血管外科臨床雜志, 2016, 23(11): 1044-1049.
13. 王希文, 趙俊剛. 單孔胸腔鏡肺癌根治術與傳統三孔手術的對比分析. 重慶醫學, 2016, 45(28): 3959-3961, 3964.
14. 肖鵬, 張曉. 單孔胸腔鏡肺葉切除術與三孔胸腔鏡肺葉切除術治療肺癌的臨床療效對照. 中國實用醫藥, 2016, 11(29): 60-61.
15. 王盛超, 張國俊, 賈明選, 等. 單孔與三孔腔鏡肺葉切除淋巴結清掃治療肺癌的比較. 現代腫瘤醫學, 2017, 25(8): 1245-1249.
16. 郝志鵬, 蔡奕欣, 付圣靈, 等. 單孔與三孔胸腔鏡肺癌根治術對患者術后疼痛及短期生活質量的對比研究. 中國肺癌雜志, 2016, 19(3): 122-128.
17. 張展飛, 梁柱, 陳銘揚, 等. 單孔與三孔胸腔鏡肺癌根治術對術后疼痛的影響. 廣東醫學院學報, 2016, 34(6): 641-643.
18. 晉云鵬, 盧喜科, 張遜, 等. 單孔與三孔胸腔鏡肺葉切除術的臨床療效對比. 天津醫藥, 2016, 44(1): 101-104.
19. 焦鵬, 李簡, 佟宏峰, 等. 近距離兩孔與單孔胸腔鏡下肺癌手術的對比. 實用醫學雜志, 2016, 32(10): 1627-1630.
20. 陳科. 單孔胸腔鏡下肺葉切除術治療周圍型肺癌的手術流程及臨床研究. 蘇州大學. 2016. 1-41.
21. 韋海濤, 李麗, 王作培, 等. 單孔與三孔胸腔鏡下肺癌根治術臨床療效的對比分析. 中華胸心血管外科雜志, 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. 葉辰陽, 柴瑩. 單孔與多孔胸腔鏡下肺葉切除術圍手術期情況的對比. 浙江大學, 2015. 1-20.
29. 謝錦寶, 陳椿. 單孔胸腔鏡與三孔胸腔鏡行肺癌根治術的臨床對比研究. 福建醫科大學, 2015. 1-30.
30. 張海, 劉繼先. 單孔與三孔法電視胸腔鏡治療原發性肺癌效果比較. 汕頭大學, 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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