Minimally invasive segmentectomy versus lobectomy for stage Ⅰ A non-small cell lung cancer:A systematic review and meta-analysis
Objective To systematically evaluate the clinical outcomes of minimally invasive lung segment resection(MILSR)and lobe resection(MILLR)for stage Ⅰ A non-small cell lung cancer(NSCLC)to provide reference for clinical application.Methods Online databases including The Cochrane Library,PubMed,EMbase,Web of Science,SinoMed,CNKI,and Wanfang were searched from inception to January 21,2023 by two researchers independently.The quality of the included literature was evaluated using the Newcastle-Ottawa Scale(NOS).The prognostic indicators included the overall survival(OS),disease-free survival(DFS)and recurrence-free survival(RFS).The meta-analysis was performed using STATA 14.0.Results A total of 13 studies with 1 853 patients were enrolled in the final study,with NOS scores ≥7 points.The results of meta-analysis showed that compared with the MILLR group,the blood loss was less[SMD=-0.36,95％CI(-0.49,-0.23),P＜0.001],postoperative drainage tube retention time[SMD=-0.34,95％CI(-0.62,-0.05),P=0.019]and hospitalization time[SMD=-0.28,95％CI(-0.40,-0.15),P＜0.001]were shorter in the MILSR group.More lymph nodes[SMD=-0.65,95％CI(-0.78,-0.53),P＜0.001]and shorter operation time[SMD=0.20,95％CI(0.07,0.33),P=0.003]were found in the MILLR group.There were no statistical differences in the incidence of postoperative complications,postoperative recurrence rate,OS,DFS or RFS between the two groups.Conclusion Although the number of lymph nodes removed by MILSR is limited compared with MILLR,it does not affect the prognosis.MILSR has advantages in reducing intraoperative blood loss and shortening postoperative drainage tube retention time and hospital stay.For the surgical treatment of stage Ⅰ A NSCLC,MILSR may be a more appropriate surgical approach.
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