ReviewSurgery for Early-Stage Non-Small Cell Lung Cancer: A Systematic Review of the Video-Assisted Thoracoscopic Surgery Versus Thoracotomy Approaches to Lobectomy
Section snippets
Data Collection
To identify relevant articles for inclusion in our analysis, we performed a structured literature retrieval of the MEDLINE database. We looked for randomized controlled, trials, observational studies, and case series that reported outcomes after either VATS or thoracotomy lobectomy for NSCLC. Our MEDLINE search algorithm (Fig 1) began by querying for non-small cell lung carcinoma (medical subject heading) and for non-small cell lung cancer (mapping term). This query yielded article abstracts
Study Characteristics
Of the 39 articles included in our analysis, 22 provided data on the VATS approach and 27 on thoracotomy. Twenty-nine manuscripts provided data on a single approach, 10 on both approaches. In aggregate, the studies involved 3256 thoracotomy lobectomy patients and 3114 VATS lobectomy patients. The two groups were not significantly different with regards to patient characteristics or tumor histology (Table 1) [4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27
Systematic Review Analysis
Level I data directly comparing VATS with thoracotomy lobectomy for the treatment of early-stage (I or II) NSCLC are not available. Rather, the literature is limited to case series and small retrospective cohort studies. Previous attempts at performing multi-institution trials to compare the outcomes of thoracotomy vs VATS lobectomy were impaired by poor accrual rates.
Speculation about one of the reasons for poor accrual was a lag in the dissemination of the technical skills necessary to
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