两种不同手术方式对非小细胞肺癌患者术后5年生存率及并发症影响的Meta分析
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摘要
目的系统评价电视胸腔镜辅助手术(VATS)与传统开胸术(OT)对非小细胞肺癌(NSCLC)术后5年生存率及并发症发生率的差异。方法搜集EMbase、Pub Med、The Cochrane Library数据库有关NSCLC患者行VATS或OT后的术后5年生存率及并发症发生率的临床研究,检索时间为建库至2017年11月。检索的文献由两名人员单独筛选,对偏倚风险进行评价后收集相关资料并交叉检查结果。采用Stata 12.0软件进行分析,评价5年生存率、心房颤动、空气泄露、肺不张、脓胸、肺炎、支气管胸膜瘘、总并发症发生率等相关指标。结果共纳入23个研究,包括5 785例NSCLC患者。Meta分析结果表明,VATS组在术后5年生存率方面优于OT组(OR=1.360,95%CI 1.099~1.683,P=0.005);VATS组心房颤动发生率(OR=0.622,95%CI 0.425~0.908,P=0.014)、空气泄露发生率(OR=0.703,95%CI 0.530~0.931,P=0.014)、脓胸发生率(OR=0.328,95%CI 0.161~0.665,P=0.002)、肺炎发生率(OR=0.591,95%CI 0.372~0.939,P=0.026)、总并发症发生率(OR=0.530,95%CI 0.439~0.639,P<0.05)均低于OT组,而两组术后肺不张发生率(OR=0.777,0.432~1.396,P=0.398)、气管胸膜瘘发生率(OR=0.948,95%CI 0.269~3.336,P=0.934)比较差异无统计学意义。结论 VATS治疗NSCLC对提高5年生存率以及降低术后并发症发生率方面优于传统开胸术。考虑到纳入结果在质和量上的局限,还需更高质量的研究来证实该结论。
Objective To systematically the effect of video-assisted thoracic surgery( VATS) and open thoracotomy( OT) on for the 5-year survival rate after operation and postoperative complications of non-small cell lung cancer( NSCLC). Methods Clinical studies about 5-year survival rate after operation and postoperative complications of different surgical methods in patients with NSCLC were searched from Pub Med,EMbase,The Cochrane Library from inception to November,2017. Two researchers independently screened literature,extracted data and evaluated the risk of bias of the included studies,and then performed Meta-analysis with the Stata 12. 0 software on the relevant indexes of 5-year survival rate,atrial fibrillation,air leakage,atelectasis,empyema,pneumonia,bronchopleural fistula,incidence of the number of total complications. Results A total of 23 studies involving 5 785 NSCLC patients were included. The results of Meta-analysis showed that: compared with OT group,the 5-year survival rate was higher than that in the VATS group( OR = 1. 360,95% CI1. 099-1. 683,P = 0. 005); incidence of atrial fibrillation( OR = 0. 622,95% CI 0. 425-0. 908,P = 0. 014),incidence of air leakage( OR = 0. 703,95% CI 0. 530-0. 931,P = 0. 014),incidence of empyema( OR = 0. 328,95% CI 0. 161-0. 665,P =0. 002),incidence of pneumonia( OR = 0. 591,95% CI 0. 372-0. 939,P = 0. 026),incidence of the number of complications( OR = 0. 530,95% CI 0. 439-0. 639,P < 0. 05) in the VATS group were lower,the differences were statistically significant.However,there was no significant difference between the two groups in incidence of atelectasis after operation( OR = 0. 777,0. 432-1. 396,P = 0. 398) and total incidence of tracheal and pleural fistula( OR = 0. 948,95% CI 0. 269-3. 336,P =0. 934). Conclusion The treatment of NSCLC by VATS is superior to traditional thoracotomy for increasing the 5-year survival rate and reducing the incidence postoperative complications. Because of the quantity and quality limitation of the included researches,the above conclusion needs to be verified by more high quality studies.
Objective To systematically the effect of video-assisted thoracic surgery( VATS) and open thoracotomy( OT) on for the 5-year survival rate after operation and postoperative complications of non-small cell lung cancer( NSCLC). Methods Clinical studies about 5-year survival rate after operation and postoperative complications of different surgical methods in patients with NSCLC were searched from Pub Med,EMbase,The Cochrane Library from inception to November,2017. Two researchers independently screened literature,extracted data and evaluated the risk of bias of the included studies,and then performed Meta-analysis with the Stata 12. 0 software on the relevant indexes of 5-year survival rate,atrial fibrillation,air leakage,atelectasis,empyema,pneumonia,bronchopleural fistula,incidence of the number of total complications. Results A total of 23 studies involving 5 785 NSCLC patients were included. The results of Meta-analysis showed that: compared with OT group,the 5-year survival rate was higher than that in the VATS group( OR = 1. 360,95% CI1. 099-1. 683,P = 0. 005); incidence of atrial fibrillation( OR = 0. 622,95% CI 0. 425-0. 908,P = 0. 014),incidence of air leakage( OR = 0. 703,95% CI 0. 530-0. 931,P = 0. 014),incidence of empyema( OR = 0. 328,95% CI 0. 161-0. 665,P =0. 002),incidence of pneumonia( OR = 0. 591,95% CI 0. 372-0. 939,P = 0. 026),incidence of the number of complications( OR = 0. 530,95% CI 0. 439-0. 639,P < 0. 05) in the VATS group were lower,the differences were statistically significant.However,there was no significant difference between the two groups in incidence of atelectasis after operation( OR = 0. 777,0. 432-1. 396,P = 0. 398) and total incidence of tracheal and pleural fistula( OR = 0. 948,95% CI 0. 269-3. 336,P =0. 934). Conclusion The treatment of NSCLC by VATS is superior to traditional thoracotomy for increasing the 5-year survival rate and reducing the incidence postoperative complications. Because of the quantity and quality limitation of the included researches,the above conclusion needs to be verified by more high quality studies.
引文
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[6]Huang HB,Ge MJ.The effects of different surgical approaches on the perioperative level of circulating tumor cells in patients with non-small cell lung cancer[J].Thorac Cardiovasc Surg,2016,64(6):515-519.
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[8]Zhang Z,Zhang Y,Feng H,et al.Is video-assisted thoracic surgery lobectomy better than thoracotomy for early-stage non-smallcell lung cancer A systematic review and meta-analysis[J].Eur J Cardio-Thorac,2013,44(3):407-414.
[9]Wang B,Lv F,Zhao L,et al.Video-assisted thoracoscope versus video-assisted mini-thoracotomy for non-small cell lung cancer:A Meta-analysis[J].Chin J Lung Cancer,2017,20(5):303-311.
[10]Cao C,Manganas C,Ang SC,et al.Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer:A metaanalysis of propensity score-matched patients[J].Interact Cardiovasc Thorac Surg,2013,16(3):244-249.
[11]Zhang X,Shi X,Han B.Comparison of short-term effect of videoassisted thoracoscopic surgery lobectomy and thoracotomy lobectomy in the treatment of non-small cell lung cancer:A systematic review[J].Chin J Lung Cancer,2012,15(7):422-428.
[12]Yang HX,Woo KM,Sima CS,et al.Long-term survival based on the surgical approach to lobectomy for clinical stageⅠnonsmall cell lung cancer:Comparison of robotic,video-assisted thoracic surgery,and thoracotomy lobectomy[J].Ann Surg,2017,265(2):431-437.
[13]Xue Y,Wang YY,Zhang K,et al.A study of complete videoassisted thoracoscopic surgery lobectomy in treatment of elderly patients with non-small cell lung cancer:Curative effect and impact on clinical prognosis[J].Cell Biochem Biophys,2015,73(2):399-404.
[14]Tane S,Noshio W,Okuma H,et al.Operative outcomes of thoracoscopic lobectomy for non-small-cell lung cancer[J].Asian Cardiovasc Thorac Ann,2015,23(8):950-957.
[15]Kuritzky AM,Aswad BI,Jones RN,et al.Lobectomy by videoassisted thoracic surgery vs muscle-sparing thoracotomy for stageⅠlung cancer:A critical evaluation of short-and long-term outcomes[J].J Am Coll Surg,2015,220(6):1044-1053.
[16]Cai HB,Li YX,Li Z.Short term curative effect of video assisted thoracoscopic lobectomy for early-stage lung cancer[J].Indian J Cancer,2015,51 Suppl 2(6):e37-41.
[17]Zhou S,Pei G,Han Y,et al.Sleeve lobectomy by video-assisted thoracic surgery versus thoracotomy for non-small cell lung cancer[J].J Cardiothorac Surg,2015,10(1):116.
[18]Smith CB,Kale M,Mhango G,et al.Comparative outcomes of elderly stageⅠlung cancer patients treated with segmentectomy via video-assisted thoracoscopic surgery versus open resection[J].J Thorac Oncol,2014,9(3):383-389.
[19]Yang H,Li XD,Lai RC,et al.Complete mediastinal lymph node dissection in video-assisted thoracoscopic lobectomy versus lobectomy by thoracotomy[J].Thorac Cardiovasc Surg,2013,61(2):116-123.
[20]Papiashvilli M,Stav D,Cyjon A,et al.Lobectomy for non-small cell lung cancer:Differences in morbidity and mortality between thoracotomy and thoracoscopy[J].Innovations,2012,7(1):15-22.
[21]Ramos R,Masuet C,Gossot D.Lobectomy for early-stage lung carcinoma:A cost analysis of full thoracoscopy versus posterolateral thoracotomy[J].Surg Endosc,2012,26(2):431-437.
[22]Cho S,Do YW,Lee EB.Comparison of costs for video-assisted thoracic surgery lobectomy and open lobectomy for non-small cell lung cancer[J].Surg Endosc,2011,25(4):1054-1061.
[23]Ilonen IK,Rasanen JV,Knuuttila A,et al.Anatomic thoracoscopic lung resection for non-small cell lung cancer in stageⅠis associated with less morbidity and shorter hospitalization than thoracotomy[J].Acta Oncol(Stockholm,Sweden),2011,50(7):1126-1132.
[24]Zhang Y,Jiang GN,Wang Q,et al.Cytokine responses after lobectomy for early non-small cell lung cancer:A prospective randomized comparison of video-assisted thoracic surgery and open thoracotomy[J].Chin J Surg,2010,48(17):1285-1288.
[25]Flores RM,Park BJ,Dycoco J,et al.Lobectomy by video-assisted thoracic surgery(VATS)versus thoracotomy for lung cancer[J].J Thorac Cardiovasc Surg,2009,138(1):11-18.
[26]Park BJ,Zhang H,Rusch VW,et al.Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy[J].J Thorac Cardiovasc Surg,2007,133(3):775-779.
[27]Whitson BA,Andrade RS,Boettcher A,et al.Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stageⅠnon-small cell lung cancer[J].Ann Thorac Surg,2007,83(6):1965-1070.
[28]Sakuraba M,Miyamoto H,Oh S,et al.Video-assisted thoracoscopic lobectomy vs.conventional lobectomy via open thoracotomy in patients with clinical stageⅠA non-small cell lung carci-noma[J].Interact Cardiovasc Thorac Surg,2007,6(5):614-617.
[29]Sawada S,Komori E,Yamasita M,et al.Comparison in prognosis after VATS lobectomy and open lobectomy for stageⅠlung cancer:Retrospective analysis focused on a histological subgroup[J].Surg Endosc,2007,21(9):1607-1611.
[30]Petersen RP,Pham D,Toloza EM,et al.Thoracoscopic lobectomy:A safe and effective strategy for patients receiving induction therapy for non-small cell lung cancer[J].Ann Thorac Surg,2006,82(1):214-218.
[31]Shiraishi T,Shirakusa T,Hiratsuka M,et al.Video-assisted thoracoscopic surgery lobectomy for c-T1N0M0 primary lung cancer:Its impact on locoregional control[J].Ann Thorac Surg,2006,82(3):1021-1026.
[32]Shigemura N,Akashi A,Funaki S,et al.Long-term outcomes after a variety of video-assisted thoracoscopic lobectomy approaches for clinical stageⅠA lung cancer:A multi-institutional study[J].J Thorac Cardiovasc Surg,2006,132(3):507-512.
[33]Tatsumi A,Ueda Y.Video-assisted thoracic surgery for lung cancer:Is it a feasible operation for stageⅠlung cancer?[J].J Thorac Cardiovasc Surg,2003,51(12):646-650.
[34]Sugi K,Kaneda Y,Esato K.Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stageⅠA lung cancer[J].World J Surg,2000,24(1):27-30.
[35]刘永军,杨婵婵.我国肺癌流行趋势及疾病负担概况[J].现代商贸工业,2016,37(2):212-213.
[36]李健,谭庆伟,顾春东,等.胸腔镜下和传统开胸手术治疗早期非小细胞肺癌的Meta分析[J].中国肿瘤外科杂志,2013,5(3):145-150.
[2]张晓,杨琼英,林国桢,等.大气污染与居民肺癌发病及死亡灰色关联分析[J].中国公共卫生,2014,30(2):165-170.
[3]刘志强,何斐,蔡琳.吸烟、被动吸烟与肺癌发病风险的病例对照研究[J].中华疾病控制杂志,2015,19(2):145-149.
[4]Zhang Y,Gao Y.Effects of VATS lobectomy,VATS anatomic segmentectomy,and open thoracotomy on pulmonary function of patients with non-small cell lung cancer[J].Chin J Cancer,2016,19(10):700-704.
[5]Bendixen M,J Rgensen OD,Kronborg C,et al.Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer:A randomised controlled trial[J].Lancet Oncol,2016,17(6):836-844.
[6]Huang HB,Ge MJ.The effects of different surgical approaches on the perioperative level of circulating tumor cells in patients with non-small cell lung cancer[J].Thorac Cardiovasc Surg,2016,64(6):515-519.
[7]Pages PB,Delpy JP,Orsini B,et al.Propensity score analysis comparing videothoracoscopic lobectomy with thoracotomy:A French Nationwide Study[J].Ann Thorac Surg,2016,101(4):1370-1378.
[8]Zhang Z,Zhang Y,Feng H,et al.Is video-assisted thoracic surgery lobectomy better than thoracotomy for early-stage non-smallcell lung cancer A systematic review and meta-analysis[J].Eur J Cardio-Thorac,2013,44(3):407-414.
[9]Wang B,Lv F,Zhao L,et al.Video-assisted thoracoscope versus video-assisted mini-thoracotomy for non-small cell lung cancer:A Meta-analysis[J].Chin J Lung Cancer,2017,20(5):303-311.
[10]Cao C,Manganas C,Ang SC,et al.Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer:A metaanalysis of propensity score-matched patients[J].Interact Cardiovasc Thorac Surg,2013,16(3):244-249.
[11]Zhang X,Shi X,Han B.Comparison of short-term effect of videoassisted thoracoscopic surgery lobectomy and thoracotomy lobectomy in the treatment of non-small cell lung cancer:A systematic review[J].Chin J Lung Cancer,2012,15(7):422-428.
[12]Yang HX,Woo KM,Sima CS,et al.Long-term survival based on the surgical approach to lobectomy for clinical stageⅠnonsmall cell lung cancer:Comparison of robotic,video-assisted thoracic surgery,and thoracotomy lobectomy[J].Ann Surg,2017,265(2):431-437.
[13]Xue Y,Wang YY,Zhang K,et al.A study of complete videoassisted thoracoscopic surgery lobectomy in treatment of elderly patients with non-small cell lung cancer:Curative effect and impact on clinical prognosis[J].Cell Biochem Biophys,2015,73(2):399-404.
[14]Tane S,Noshio W,Okuma H,et al.Operative outcomes of thoracoscopic lobectomy for non-small-cell lung cancer[J].Asian Cardiovasc Thorac Ann,2015,23(8):950-957.
[15]Kuritzky AM,Aswad BI,Jones RN,et al.Lobectomy by videoassisted thoracic surgery vs muscle-sparing thoracotomy for stageⅠlung cancer:A critical evaluation of short-and long-term outcomes[J].J Am Coll Surg,2015,220(6):1044-1053.
[16]Cai HB,Li YX,Li Z.Short term curative effect of video assisted thoracoscopic lobectomy for early-stage lung cancer[J].Indian J Cancer,2015,51 Suppl 2(6):e37-41.
[17]Zhou S,Pei G,Han Y,et al.Sleeve lobectomy by video-assisted thoracic surgery versus thoracotomy for non-small cell lung cancer[J].J Cardiothorac Surg,2015,10(1):116.
[18]Smith CB,Kale M,Mhango G,et al.Comparative outcomes of elderly stageⅠlung cancer patients treated with segmentectomy via video-assisted thoracoscopic surgery versus open resection[J].J Thorac Oncol,2014,9(3):383-389.
[19]Yang H,Li XD,Lai RC,et al.Complete mediastinal lymph node dissection in video-assisted thoracoscopic lobectomy versus lobectomy by thoracotomy[J].Thorac Cardiovasc Surg,2013,61(2):116-123.
[20]Papiashvilli M,Stav D,Cyjon A,et al.Lobectomy for non-small cell lung cancer:Differences in morbidity and mortality between thoracotomy and thoracoscopy[J].Innovations,2012,7(1):15-22.
[21]Ramos R,Masuet C,Gossot D.Lobectomy for early-stage lung carcinoma:A cost analysis of full thoracoscopy versus posterolateral thoracotomy[J].Surg Endosc,2012,26(2):431-437.
[22]Cho S,Do YW,Lee EB.Comparison of costs for video-assisted thoracic surgery lobectomy and open lobectomy for non-small cell lung cancer[J].Surg Endosc,2011,25(4):1054-1061.
[23]Ilonen IK,Rasanen JV,Knuuttila A,et al.Anatomic thoracoscopic lung resection for non-small cell lung cancer in stageⅠis associated with less morbidity and shorter hospitalization than thoracotomy[J].Acta Oncol(Stockholm,Sweden),2011,50(7):1126-1132.
[24]Zhang Y,Jiang GN,Wang Q,et al.Cytokine responses after lobectomy for early non-small cell lung cancer:A prospective randomized comparison of video-assisted thoracic surgery and open thoracotomy[J].Chin J Surg,2010,48(17):1285-1288.
[25]Flores RM,Park BJ,Dycoco J,et al.Lobectomy by video-assisted thoracic surgery(VATS)versus thoracotomy for lung cancer[J].J Thorac Cardiovasc Surg,2009,138(1):11-18.
[26]Park BJ,Zhang H,Rusch VW,et al.Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy[J].J Thorac Cardiovasc Surg,2007,133(3):775-779.
[27]Whitson BA,Andrade RS,Boettcher A,et al.Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stageⅠnon-small cell lung cancer[J].Ann Thorac Surg,2007,83(6):1965-1070.
[28]Sakuraba M,Miyamoto H,Oh S,et al.Video-assisted thoracoscopic lobectomy vs.conventional lobectomy via open thoracotomy in patients with clinical stageⅠA non-small cell lung carci-noma[J].Interact Cardiovasc Thorac Surg,2007,6(5):614-617.
[29]Sawada S,Komori E,Yamasita M,et al.Comparison in prognosis after VATS lobectomy and open lobectomy for stageⅠlung cancer:Retrospective analysis focused on a histological subgroup[J].Surg Endosc,2007,21(9):1607-1611.
[30]Petersen RP,Pham D,Toloza EM,et al.Thoracoscopic lobectomy:A safe and effective strategy for patients receiving induction therapy for non-small cell lung cancer[J].Ann Thorac Surg,2006,82(1):214-218.
[31]Shiraishi T,Shirakusa T,Hiratsuka M,et al.Video-assisted thoracoscopic surgery lobectomy for c-T1N0M0 primary lung cancer:Its impact on locoregional control[J].Ann Thorac Surg,2006,82(3):1021-1026.
[32]Shigemura N,Akashi A,Funaki S,et al.Long-term outcomes after a variety of video-assisted thoracoscopic lobectomy approaches for clinical stageⅠA lung cancer:A multi-institutional study[J].J Thorac Cardiovasc Surg,2006,132(3):507-512.
[33]Tatsumi A,Ueda Y.Video-assisted thoracic surgery for lung cancer:Is it a feasible operation for stageⅠlung cancer?[J].J Thorac Cardiovasc Surg,2003,51(12):646-650.
[34]Sugi K,Kaneda Y,Esato K.Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stageⅠA lung cancer[J].World J Surg,2000,24(1):27-30.
[35]刘永军,杨婵婵.我国肺癌流行趋势及疾病负担概况[J].现代商贸工业,2016,37(2):212-213.
[36]李健,谭庆伟,顾春东,等.胸腔镜下和传统开胸手术治疗早期非小细胞肺癌的Meta分析[J].中国肿瘤外科杂志,2013,5(3):145-150.