Meta-analysis Of Short-term Efficacy Of Thoracoscopic Segmentectomy And Lobectomy

Research Background:Lung cancer is the most common malignant tumor in clinic.In recent years,with the aggravation of environmental pollution,the incidence and mortality of lung cancer are significantly higher than other malignant tumors,and it ranks first in male malignant tumors,and third and second in female malignant tumors.In China,the incidence and mortality of lung malignant tumors rank first among malignant tumors.Because early lung cancer patients have no obvious clinical manifestations and symptoms,so that patients can not be found in time,waiting for clinical manifestations or symptoms,often too late,may have been in the middle and late stages of medical treatment,making most patients lose the opportunity of early diagnosis,and make them lose the possibility of obtaining better long-term survival rate.With the continuous improvement of medical diagnosis and treatment technology,especially the wide application of PET/CT and LDCT in imaging,more patients with highly suspected lung cancer can be detected in time through LDCT screening,so as to achieve the effect of early detection,early diagnosis and early treatment,and reduce the mortality of lung cancer.Although the level of medical treatment is constantly improving,and the methods of diagnosis and treatment of lung cancer are constantly updated.From surgery,chemotherapy,radiotherapy and other means to the emergence of novel targeted therapy,gene immunotherapy and other means,the survival rate of lung cancer patients has improved,but the overall five-year survival rate of lung cancer is still not high.Surgical resection is still the first choice for the treatment of lung cancer in the early and middle stages of non-small cell lung cancer.With the growing maturity of endoscopy technology and the continuous innovation of endoscopy equipment,most types of surgery can be completed by using endoscopy technology,and surgical treatment of lung cancer is no exception.The National Comprehensive Cancer Network(NCCN)of the United States has adopted thoracoscopic anatomical lobectomy and systematic lymph node dissection as a radical treatment for lung cancer(type 1 recommended evidence).Some scholars have suggested that thoracoscopic pulmonary segmentectomy(TPS)is more conducive to early recovery of patients.Research purposes: To compare the short-term efficacy of thoracoscopic lobectomy(TPL)with thoracoscopic segmentectomy(TPS)through meta-analysis.Research methods:Through the computer to search all relevant literatures such as China Knowledge Network Database(CNKI),Wanfang Database,VIP Database(VIP),EMBASE,Cochrane Library,PUBMED/ MEDLINE,etc.,manual search and research content related magazines and conference proceedings.All relevant literatures on the treatment of early stage lung cancer by thoracoscopic segmental resection(TPS)and thoracoscopic lobectomy(TPL)were collected.The selected literature was included in the standard screening and included in the literature,and the included literature was scored.To extract the required data,establish a database,and analyze the data by using Rev Man 5.3 software.Result:A preliminary search of 1195 articles,rigorous screening of the literature according to the inclusion criteria,and finally obtained a total of 16 Chinese and English literature,including 15 Chinese literature,1 English literature,13 randomized controlled trials(RCT),prospective Study 3 articles.The total number of cases was 1516,of which the number of cases in the TPS group was 741,and the number of cases in the TPL group was 775.After analysis,the results showed that there was no statistically significant difference in intraoperative blood loss between TPS and TPL,but there was still a trend superior to lobectomy(P=0.18),and there was no significant difference in operation time(P=0.60).The total drainage volume of the drainage tube after TPS was less than that after TPL(MD=-171.30,95% CI=[-202.18,-140.42],P=0.00001).The drainage time of the drainage tube after TPS was also shorter than that after TPL(MD =-0.89,95% CI = [-1.58,-0.62],P=0.004 <0.05).Moreover,TPS can shorten the hospital stay of patients compared with TPL(MD=-0.82,95% CI=[-1.33,-0.30],P=0.002).There were no significant differences in postoperative cardio-pulmonary complications after surgery.Statistical descriptive analysis showed that: due to the inconsistent time standard of postoperative pulmonary function measurement mentioned in the literature,no meta-analysis was performed.There were 11 articles describing the comparison of lung function before and after the two procedures,all showing chest cavity.The effect of postoperative segmental resection(TPS)on respiratory function was smaller than that of thoracoscopic lobectomy(TPL).Conclusion: Compared with thoracoscopic pulmonary lobectomy(TPL),thoracoscopic segmentectomy(TPS)is more conducive to early recovery and better short-term results.