Single-incision Versus Multiport Video-assisted Thoracoscopic Surgery In The Treatment Of Lung Cancer:A Systematic Review And Meta-analysis

Objectives: Recent studies compared single-incision thoracoscopic surgery(SITS) with more widely used conventional multiport video-assisted thoracoscopic surgery (VATS) in the treatment of lung cancer. To establish the safety and feasible of SITS in the treatment of lung cancer, we conducted this systematic review and meta-analysis.Methods: 11 studies were identified from the databases of PubMed, Cochrane Library, Springer Link, and Science Direct. The randomized controlled trials (RCTs)and non-randomized studies evaluated the outcomes (including operation time, blood loss amount, mean duration of chest tube, postoperative hospital stay, lymph nodes retrieved, or complication rate) of SITS compared with multiport VATS in the treatment of lung cancer were included for analysis. Odds ratio (OR, used to compare dichotomous variables) and weight mean difference (WMD, used to compare continuous variables) were calculated with 95% confidence intervals (CIs) based on intention-to-treat analysis. The retrieval time was from inception to December 30,2016. Data were extracted and evalued by two reviewers independently. Then meta-analysis was performed using RevMan 5.0 software (Cochrane Collaboration,Oxford, UK) and STATA 11.2 software (StataCorp, College Station, Texas USA).Results: 11 studies including 1,314 patients were included for analysis. Our analysis showed that the operative time [WMD=9.39min,95%CI(-7.48,26.26),p=0.28], blood loss amount [WMD=-7.70mL,95%CI(-20.02,4.62),p=0.22], mean duration of chest tube [WMD=-0.72d,95%CI(-1.44,0.002),p=0.051], lymph nodes retrieved [WMD=-0.45, 95%CI(-1.03,0.13),p=0.13]were similar between two approaches, the SITS pulmonary resection might be associated with shorter hospital stay [WMD=-0.50d,95%CI(-0.87,-0.13),p=0.008] and lower complication rate[OR=0.64,95%CI(0.45,0.90), p=0.009],p=0.009] when compared with conventional multiport VATS approaches.Conclusions: Our meta-analysis indicates that SITS is a safe and feasible approach and could beconsidered as alternative to conventional multiport VATS in the treatment of lung cancer. SITS might be associated with shorter hospital stay and lower complication when compared with conventional multiport VATS.