Clinical efficacy of endoscopic minimally invasive versus median sternotomy thoracotomy for atrial myxoma: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Xu ¹ , YI Fan ² , HUO Qiang ¹ ,  AI SiKaEr ShaBiTi ¹

1. Department of Cardiac Surgery Division One, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P. R. China;
2. Department of Gastroenterology, Urumqi Traditional Chinese Medicine Hospital, Urumqi, 830000, P. R. China;

Corresponding?author：

AI SiKaEr ShaBiTi, Email: z838027993@163.com

Keywords：

Atrial myxoma; thoracoscopy; robot; minimally invasive surgery; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202010012

Video：

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Objective To compare the clinical efficacy of endoscopic minimally invasive surgery and median sternotomy thoracotomy in the treatment of atrial myxoma by meta-analysis.Methods We searched CBM, CNKI, Wanfang Data, VIP, PubMed, the Cochrane Library and EMbase to collect relevant researches on atrial myxoma and endoscopic minimally invasive surgery. The retrieval time was from the establishment of the database to September 2020. Two reviewers independently screened the literature, extracted data and evaluated the bias risk of included studies by the Newcastle-Ottawa scale (NOS). Then, the meta-analysis was performed by Stata 16.0.Results Ten articles were included in the study, all of which were case-control studies. The quality of literature was grade B in 5 articles and grade A in 5 articles. The sample size of surgery was 938 patients, including 480 patients in the endoscopic minimally invasive group, 458 patients in the median thoracotomy group, and 595 patients in follow-up. A total of 18 outcome indexes were included in the meta-analysis. The combined results of 9 outcome indicators were statistically significant: cardiopulmonary bypass time (SMD=0.32, 95%CI 0.00 to 0.63, P=0.048); ventilator assisted ventilation time (SMD=?0.35, 95%CI ?0.56 to ?0.15, P=0.001), ICU stay time (SMD=–0.42, 95%CI ?0.62 to ?0.21, P<0.001); postoperative hospitalization time (SMD=?0.91, 95%CI ?1.22 to ?0.60, P<0.001); postoperative drainage volume (SMD=?2.48, 95%CI ?5.24 to 0.28, P<0.001); postoperative new onset atrial fibrillation (OR=0.29, 95%CI 0.12 to 0.67, P= 0.005); postoperative pneumonia (OR=0.09, 95%CI 0.02 to 0.36, P=0.001); postoperative blood transfusion (OR=0.22, 95%CI 0.11 to 0.45, P<0.001); incision satisfaction (OR=83.15, 95%CI 1.24 to 5563.29, P=0.039).Conclusion Available evidence suggests that median thoracotomy requires shorter cardiopulmonary bypass time than endoscopic minimally invasive surgery; during the 5-year follow-up after surgery and discharge, ICU stay time, postoperative hospital stay, postoperative drainage, new atrial fibrillation after surgery, postoperative pneumonia, postoperative blood transfusion, satisfactory incision, endoscopic minimally invasive surgery showed better results than median sternotomy thoracotomy.

Citation： ZHANG Xu, YI Fan, HUO Qiang, AI SiKaEr ShaBiTi. Clinical efficacy of endoscopic minimally invasive versus median sternotomy thoracotomy for atrial myxoma: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(9): 1189-1196. doi: 10.7507/1007-4848.202010012 Copy

1.	Yuan SM, Yan SL, Wu N. Unusual aspects of cardiac myxoma. Anatol J Cardiol, 2017, 17(3): 241-247.
2.	Stefanou MI, Rath D, Stadler V, et al. Cardiac myxoma and cerebrovascular events: A retrospective cohort study. Front Neurol, 2018, 9: 823.
3.	劉浪, 曹勇, 陳凱明, 等. 原發性心臟腫瘤外科手術的臨床療效分析. 中國循證心血管醫學雜志, 2020, 12(5): 558-560, 565.
4.	覃庚亮, 趙明一, 鐘穎, 等. 心臟黏液瘤的診治進展. 嶺南心血管病雜志, 2020, 26(2): 123-127.
5.	劉宇航, 周更須, 王寧, 等. 自體心臟移植術離體切除嬰兒原發性心臟腫瘤一例并文獻復習. 中華小兒外科雜志, 2020, 41(7): 623-627.
6.	Ramlawi B, AI-Jabbari O, Blau LN, et al. Autotransplantation for the resection of complex left heart tumors. Ann Thorac Surg, 2014, 98(3): 863-868.
7.	Li S, Gao Ch. Surgical experience of primary cardiac tumor: Single-institution 23-year report. Med Sci Monit, 2017, 23: 2111-2117.
8.	Nisivaco S, Henry M, Ward RP, et al. Totally endoscopic robotic-assisted excision of right ventricular papillary fibroelastoma. J Robot Surg, 2019, 13(6): 779-782.
9.	劉鳴, 主編. 系統評價Meta分析設計與實施方法. 第2版. 北京: 人民衛生出版社, 2011. 72-73.
10.	劉健, 郭惠明, 謝斌, 等. 胸腔鏡下與傳統開胸左心房粘液瘤切除術的病例對照研究. 中國胸心血管外科臨床雜志, 2016, 23(7): 671-674.
11.	覃庚亮. 心臟粘液瘤的臨床特點分析及手術方式探討. 廣州: 南方醫科大學, 2019.
12.	李雙磊, 高長青. 機器人手術與傳統開胸手術在心臟腫瘤患者治療中的對比: 傾向評分匹配分析. 南方醫科大學學報, 2017, 37(10): 1296-1300.
13.	Moss E, Halkos ME, Miller JS, et al. Comparison of endoscopic robotic versus sternotomy approach for the resection of left atrial tumors. Innovations (Phila), 2016, 11(4): 274-277.
14.	Kes?vuori R, Raivio P, Jokinen JJ, et al. Quality of life after robotically assisted atrial myxoma excision. J Robot Surg, 2015, 9(3): 235-241.
15.	Yang M, Yao M, Wang G, et al. Comparison of postoperative quality of life for patients who undergo atrial myxoma excision with robotically assisted versus conventional surgery. J Thorac Cardiovasc Surg, 2015, 150(1): 152-157.
16.	Schilling J, Engel AM, Hassan M, et al. Robotic excision of atrial myxoma. J Card Surg, 2012, 27(4): 423-426.
17.	Deng L, Zhang GW, Liu ZH, et al. Totally thoracoscopic surgery for atrial myxomas resection and atrial septal defect repair. Eur Rev Med Pharmacol Sci, 2017, 21(3): 569-575.
18.	Sawaki S, Ito T, Maekawa A, et al. Outcomes of video-assisted minimally invasive approach through right mini-thoracotomy for resection of benign cardiac masses; compared with median sternotomy. Gen Thorac Cardiovasc Surg, 2015, 63(3): 142-146.
19.	賀清. 完全胸腔鏡與傳統正中開胸手術治療心臟粘液瘤的臨床對比研究. 西安: 第四軍醫大學, 2018.
20.	Chen J, Yang ZG, Ma ES, et al. Preoperative assessment of mitral valve abnormalities in left atrial myxoma patients using cardiac CT. Oncotarget, 2017, 8(34): 57583-57593.
21.	Kewcharoen J, Prasongdee K, Sinphurmsukskul S, et al. Recurrent cardiac myxoma treated by orthotopic heart transplantation: A case report and literature review of heart transplantation for primary cardiac tumor. Case Rep Transplant. 2018, 2018: 2456949.
22.	Falk V, Cheng DC, Martin J, et al. Minimally invasive versus open mitral valve surgery: A consensus statement of the international society of minimally invasive coronary surgery (ISMICS) 2010. Innovations (Phila), 2011, 6(2): 66-76.
23.	程才, 魏翔. 系統化、精準化、個體化的微創心臟外科體系. 臨床外科雜志, 2017, 25(5): 343-345.
24.	Ellouze M, Pellerin M, Jeanmart H, et al. Mini right anterior thoracotomy approach versus sternotomy for resection of intracardiac myxoma. Innovations (Phila), 2018, 13(4): 292-295.

1. Yuan SM, Yan SL, Wu N. Unusual aspects of cardiac myxoma. Anatol J Cardiol, 2017, 17(3): 241-247.
2. Stefanou MI, Rath D, Stadler V, et al. Cardiac myxoma and cerebrovascular events: A retrospective cohort study. Front Neurol, 2018, 9: 823.
3. 劉浪, 曹勇, 陳凱明, 等. 原發性心臟腫瘤外科手術的臨床療效分析. 中國循證心血管醫學雜志, 2020, 12(5): 558-560, 565.
4. 覃庚亮, 趙明一, 鐘穎, 等. 心臟黏液瘤的診治進展. 嶺南心血管病雜志, 2020, 26(2): 123-127.
5. 劉宇航, 周更須, 王寧, 等. 自體心臟移植術離體切除嬰兒原發性心臟腫瘤一例并文獻復習. 中華小兒外科雜志, 2020, 41(7): 623-627.
6. Ramlawi B, AI-Jabbari O, Blau LN, et al. Autotransplantation for the resection of complex left heart tumors. Ann Thorac Surg, 2014, 98(3): 863-868.
7. Li S, Gao Ch. Surgical experience of primary cardiac tumor: Single-institution 23-year report. Med Sci Monit, 2017, 23: 2111-2117.
8. Nisivaco S, Henry M, Ward RP, et al. Totally endoscopic robotic-assisted excision of right ventricular papillary fibroelastoma. J Robot Surg, 2019, 13(6): 779-782.
9. 劉鳴, 主編. 系統評價Meta分析設計與實施方法. 第2版. 北京: 人民衛生出版社, 2011. 72-73.
10. 劉健, 郭惠明, 謝斌, 等. 胸腔鏡下與傳統開胸左心房粘液瘤切除術的病例對照研究. 中國胸心血管外科臨床雜志, 2016, 23(7): 671-674.
11. 覃庚亮. 心臟粘液瘤的臨床特點分析及手術方式探討. 廣州: 南方醫科大學, 2019.
12. 李雙磊, 高長青. 機器人手術與傳統開胸手術在心臟腫瘤患者治療中的對比: 傾向評分匹配分析. 南方醫科大學學報, 2017, 37(10): 1296-1300.
13. Moss E, Halkos ME, Miller JS, et al. Comparison of endoscopic robotic versus sternotomy approach for the resection of left atrial tumors. Innovations (Phila), 2016, 11(4): 274-277.
14. Kes?vuori R, Raivio P, Jokinen JJ, et al. Quality of life after robotically assisted atrial myxoma excision. J Robot Surg, 2015, 9(3): 235-241.
15. Yang M, Yao M, Wang G, et al. Comparison of postoperative quality of life for patients who undergo atrial myxoma excision with robotically assisted versus conventional surgery. J Thorac Cardiovasc Surg, 2015, 150(1): 152-157.
16. Schilling J, Engel AM, Hassan M, et al. Robotic excision of atrial myxoma. J Card Surg, 2012, 27(4): 423-426.
17. Deng L, Zhang GW, Liu ZH, et al. Totally thoracoscopic surgery for atrial myxomas resection and atrial septal defect repair. Eur Rev Med Pharmacol Sci, 2017, 21(3): 569-575.
18. Sawaki S, Ito T, Maekawa A, et al. Outcomes of video-assisted minimally invasive approach through right mini-thoracotomy for resection of benign cardiac masses; compared with median sternotomy. Gen Thorac Cardiovasc Surg, 2015, 63(3): 142-146.
19. 賀清. 完全胸腔鏡與傳統正中開胸手術治療心臟粘液瘤的臨床對比研究. 西安: 第四軍醫大學, 2018.
20. Chen J, Yang ZG, Ma ES, et al. Preoperative assessment of mitral valve abnormalities in left atrial myxoma patients using cardiac CT. Oncotarget, 2017, 8(34): 57583-57593.
21. Kewcharoen J, Prasongdee K, Sinphurmsukskul S, et al. Recurrent cardiac myxoma treated by orthotopic heart transplantation: A case report and literature review of heart transplantation for primary cardiac tumor. Case Rep Transplant. 2018, 2018: 2456949.
22. Falk V, Cheng DC, Martin J, et al. Minimally invasive versus open mitral valve surgery: A consensus statement of the international society of minimally invasive coronary surgery (ISMICS) 2010. Innovations (Phila), 2011, 6(2): 66-76.
23. 程才, 魏翔. 系統化、精準化、個體化的微創心臟外科體系. 臨床外科雜志, 2017, 25(5): 343-345.
24. Ellouze M, Pellerin M, Jeanmart H, et al. Mini right anterior thoracotomy approach versus sternotomy for resection of intracardiac myxoma. Innovations (Phila), 2018, 13(4): 292-295.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical efficacy of endoscopic minimally invasive versus median sternotomy thoracotomy for atrial myxoma: A systematic review and meta-analysis

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