Comparative Effectiveness of Surgical Approaches for Lung Cancer
Autor: | Samuel Kim, Ankit Bharat, Emily Cerier, David D. Odell, Lorenzo L. Pesce, Melissa Querrey, Adwaiy Manerikar |
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Rok vydání: | 2021 |
Předmět: |
medicine.medical_specialty
Lung Neoplasms Time Factors non-small cell lung cancer (NSCLC) Cochrane Library Risk Assessment Article 03 medical and health sciences Postoperative Complications 0302 clinical medicine Robotic Surgical Procedures Internal medicine medicine Humans Pneumonectomy Propensity Score Lung cancer Neoplasm Staging Thoracic Surgery Video-Assisted business.industry Odds ratio medicine.disease Confidence interval Treatment Outcome Thoracotomy 030220 oncology & carcinogenesis Relative risk Meta-analysis Propensity score matching 030211 gastroenterology & hepatology Surgery business |
Zdroj: | J Surg Res |
ISSN: | 0022-4804 |
Popis: | Background The magnitude of association and quality of evidence comparing surgical approaches for lung cancer resection has not been analyzed. This has resulted in conflicting information regarding the relative superiority of the different approaches and disparate opinions on the optimal surgical treatment. We reviewed and systematically analyzed all published data comparing near- (30-d) and long-term mortality for minimally invasive to open surgical approaches for lung cancer. Methods Comprehensive search of EMBASE, MEDLINE, and the Cochrane Library, from January 2009 to August 2019, was performed to identify the studies and those that passed bias assessment were included in the analysis utilizing propensity score matching techniques. Meta-analysis was performed using random-effects and fixed-effects models. Risk of bias was assessed via the Newcastle–Ottawa Scale and the ROBINS-I tool. The study was registered in PROSPERO (CRD42020150923) prior to analysis. Results Overall, 1382 publications were identified but 19 studies were included encompassing 47,054 patients after matching. Minimally invasive techniques were found to be superior with respect to near-term mortality in early and advanced-stage lung cancer (risk ratio 0.45, 95% confidence interval [CI] 0.21-0.95, I2 = 0%) as well as for elderly patients (odds ratio 0.45, 95% CI 0.31-0.65, I2 = 30%), but did not demonstrate benefit for high-risk patients (odds ratio 0.74, 95% CI 0.06-8.73, I2 = 78%). However, no difference was found in long-term survival. Conclusions We performed the first systematic review and meta-analysis to compare surgical approaches for lung cancer which indicated that minimally invasive techniques may be superior to thoracotomy in near-term mortality, but there is no difference in long-term outcomes. |
Databáze: | OpenAIRE |
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