Minimally invasive surgery versus thoracotomy for locally advanced lung cancers: A systematic review and meta-analysis.

BACKGROUND

Locally advanced lung cancer is generally regarded as a relative contraindication for minimally invasive surgical approaches. The comparative outcomes between minimally invasive techniques and conventional open thoracotomy in this specific patient population have not been adequately investigated through rigorous clinical studies.

METHODS

We systematically searched Embase, Cochrane Library, PubMed, MEDLINE, and Web of Science for studies comparing minimally invasive (robotic and laparoscopic) approaches with conventional open thoracotomy. Pooled standard mean differences, relative risks, and 95% confidence intervals were calculated. The study protocol was registered with PROSPERO (CRD42024526598).

RESULTS

There were 7819 participants including 15 articles. Compared with open thoracotomy, patients undergoing minimally invasive surgery (MIS) demonstrated significantly shorter operative time (SMD = 0.13; 95% CI = 0.01-0.24; I2=49.9%, P = .036) and reduced hospital stay (SMD = -0.19; 95% CI = -0.24 to -0.14; I2=45.6%, P < .001). However, no significant differences were observed in blood loss, ICU days, chest tube duration, lymph node resected, lymph node total stations, complications, acute respiratory distress syndrome (ARDS), atrial arrhythmia, chylothorax, prolonged air leak, pneumonia, and overall recurrence.

CONCLUSION

MIS demonstrates significant advantages over thoracotomy in terms of operative time and hospital stay for locally advanced lung cancer. However, no statistically significant differences were observed in blood loss, ICU days, chest tube duration, lymph nodes resected, lymph nodes total stations, complications, ARDS, atrial arrhythmia, chylothorax, prolonged air leak, pneumonia, and overall recurrence. More high-quality literature is needed to be included in the research in the future.