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.	魏德勝. 微創手術在胸腺瘤并重癥肌無力外科治療中的應用. 中華全科醫學, 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.	俞暉. 電視胸腔鏡下手術治療胸腺瘤與傳統手術治療的臨床對比研究. 臨床和實驗醫學雜志, 2014, 13(19): 1615-1618.
10.	李富, 李標. 胸腔鏡與開胸手術治療重癥肌無力合并胸腺瘤療效對于分析. 河北醫藥, 2014, 36(20): 3088-3089.
11.	文石兵, 胡定中, 何林峰. 微創手術治療老年胸腺瘤的臨床分析. 中華全科醫學, 2013, 11(11): 1707-1708.
12.	齊瑞. 胸腔鏡與開胸手術治療重癥肌無力合并胸腺瘤的隨機對照研究. 中國醫學工程, 2015, 23(9): 79-81.
13.	任自學, 王圣應, 張榮新. 電視胸腔鏡手術與傳統手術治療胸腺瘤療效比較. 新鄉醫學院學報, 2014, 31(7): 544-545.
14.	羅國軍, 莊江能, 李卓東, 等. 胸腺瘤不同外科手術方式的臨床對比研究. 中華全科醫學, 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. 魏德勝. 微創手術在胸腺瘤并重癥肌無力外科治療中的應用. 中華全科醫學, 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. 俞暉. 電視胸腔鏡下手術治療胸腺瘤與傳統手術治療的臨床對比研究. 臨床和實驗醫學雜志, 2014, 13(19): 1615-1618.
10. 李富, 李標. 胸腔鏡與開胸手術治療重癥肌無力合并胸腺瘤療效對于分析. 河北醫藥, 2014, 36(20): 3088-3089.
11. 文石兵, 胡定中, 何林峰. 微創手術治療老年胸腺瘤的臨床分析. 中華全科醫學, 2013, 11(11): 1707-1708.
12. 齊瑞. 胸腔鏡與開胸手術治療重癥肌無力合并胸腺瘤的隨機對照研究. 中國醫學工程, 2015, 23(9): 79-81.
13. 任自學, 王圣應, 張榮新. 電視胸腔鏡手術與傳統手術治療胸腺瘤療效比較. 新鄉醫學院學報, 2014, 31(7): 544-545.
14. 羅國軍, 莊江能, 李卓東, 等. 胸腺瘤不同外科手術方式的臨床對比研究. 中華全科醫學, 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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