A Meta-analysis Of The Clinical Efficacy Of Thoracoscopic Wedge Resection And Segment Resection In The Treatment Of Early Lung Cancer

Purpose: To compare the safety and clinical efficacy of the two surgical methods,wedge resection and segmentectomy under thoracoscopic surgery,and to make reference for clinical selection.Methods: Search PubMed,Embase,The Cochrane Library,CNKI database,Wanfang database published before December 2020 on the comparison of thoracoscopic wedge resection and segmentectomy for the treatment of early lung cancer.The methodological quality evaluation of the included non-randomized controlled studies was evaluated according to the New castle-Ottawa Scale(NOS)standard.Use Rev Man5.4 software provided by Cochrane Collaboration to conduct meta-analysis.Results: The results of meta-analysis showed that there was a statistically significant difference in the incidence of postoperative complications between thoracoscopic wedge resection and segment resection in the treatment of early lung cancer(OR 0.54,CI95% 0.40～0.75,P=0.0002)There was a statistically significant difference in the incidence of postoperative persistent air leakage(OR 0.41,CI95% 0.25～0.70,P=0.0009),and no significant difference in the incidence of postoperative lung infection(OR 0.59,CI95% 0.26～ 1.34,P=0.21),there was no significant difference in the incidence of postoperative respiratory failure(OR 0.86,CI95% 0.21～3.53,P=0.83),and the difference in operation time was statistically significant(MD-11.22,CI95%-14.07～-8.37,P<0.00001),the difference in postoperative hospitalization days was statistically significant(MD-1.57,CI95%-1.97～-1.17,P<0.00001),and the difference in postoperative recurrence rate was statistically significant(OR 1.92,CI95% 1.04～3.58,P=0.04),there was no significant difference in 30-day mortality after surgery(OR 0.99,CI95% 0.34～2.84,P=0.98).Conclusion: Compared with segmentectomy under thoracoscopic lung wedge resection,the total postoperative complications,the incidence of persistent air leakage are lower,the duration of surgery,postoperative hospital stay,and the incidence of pulmonary infection are lower.There was no statistically significant difference in the incidence of respiratory failure and mortality within 30 days after surgery,and the rate of local recurrence after surgery was higher.Although the overall postoperative complication rate of thoracoscopic segmental resection is higher,the30-day postoperative mortality rate of the two surgical methods is very low.The safety of patients with both types of surgery is good,and the increase in complication rate does not translate into an increase in postoperative mortality,although thoracoscopic segmentectomy will lead to prolonged operation time and postoperative hospitalization.Although the appeals will cause different degrees of distress to patients,thoracoscopic segmentectomy can reduce the chance of local recurrence after surgery without increasing the perioperative mortality.In summary,perhaps thoracoscopic segmentectomy is a more suitable method of intentional sublobectomy for patients with early-stage lung cancer.