Abstract
Background
Although minimally invasive lobectomy has gained worldwide interest, there has been
debate on perioperative and oncological outcomes. The purpose of this study was to
compare outcomes among open lobectomy, video-assisted thoracic surgery lobectomy,
and robotic lobectomy.
Methods
PubMed, EMBASE, and Web of Science databases were consulted. A fully Bayesian network
meta-analysis was performed.
Results
Thirty-four studies (183,426 patients) were included; 88,865 (48.4%) underwent open
lobectomy, 79,171 (43.2%) video-assisted thoracic surgery lobectomy, and 15,390 (8.4%)
robotic lobectomy. Compared with open lobectomy, video-assisted thoracic surgery,
lobectomy and robotic lobectomy had significantly reduced 30-day mortality (risk ratio =
0.53; 95% credible intervals, 0.40–0.66 and risk ratio = 0.51; 95% credible intervals,
0.36–0.71), pulmonary complications (risk ratio = 0.70; 95% credible intervals, 0.51–0.92
and risk ratio = 0.69; 95% credible intervals, 0.51–0.88), and overall complications
(risk ratio = 0.77; 95% credible intervals, 0.68–0.85 and risk ratio = 0.79; 95% credible
intervals, 0.67–0.91). Compared with video-assisted thoracic surgery lobectomy, open
lobectomy, and robotic lobectomy had a significantly higher total number of harvested
lymph nodes (mean difference = 1.46; 95% credible intervals, 0.30, 2.64 and mean difference =
2.18; 95% credible intervals, 0.52–3.92) and lymph nodes stations (mean difference =
0.37; 95% credible intervals, 0.08–0.65 and mean difference = 0.93; 95% credible intervals,
0.47–1.40). Positive resection margin and 5-year overall survival were similar across
treatments. Intraoperative blood loss, postoperative transfusion, hospital length
of stay, and 30-day readmission were significantly reduced for minimally invasive
approaches.
Conclusion
Compared with open lobectomy, video-assisted thoracic surgery lobectomy, and robotic
lobectomy seem safer with reduced 30-day mortality, pulmonary, and overall complications
with equivalent oncologic outcomes and 5-year overall survival. Minimally invasive
techniques may improve outcomes and surgeons should be encouraged, when feasible,
to adopt video-assisted thoracic surgery lobectomy, or robotic lobectomy in the treatment
of lung cancer.
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Article info
Publication history
Published online: October 20, 2020
Accepted:
September 12,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
