Outcomes of Video-Assisted Thoracic Surgery Compared to Open Thoracic Surgery for Pulmonary Hydatid Disease: A Systematic Review and Meta-Analysis

IF 2.5 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation Pub Date : 2026-10-01 Epub Date: 2026-08-03 DOI:10.1016/j.hlc.2026.02.021

Ayham Mohammad Hussein MD, Bara M. Hammadeh MD, Abdullah Yousef Aldalati MD, Moath Albliwi MD, Ramez M. Odat MMD, Amin Shabaneh MD

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引用次数: 0

Abstract

Background & Aim

Pulmonary echinococcosis, or pulmonary hydatid disease, caused by Echinococcus larvae, presents a significant health challenge, particularly in endemic areas. While surgery is the primary treatment for viable cysts, the optimal approach for this remains under debate. There is a lack of comparative evidence comparing traditional open thoracic surgery (OTS) with minimally invasive video-assisted thoracic surgery (VATS). This systematic review and meta-analysis aims to comprehensively compare the efficacy and safety of VATS versus OTS for pulmonary hydatid disease; it will expand on prior research by including patients of all ages and conducting detailed subgroup analyses, sensitivity analyses, and publication bias assessments.

Method

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and International Prospective Register of Systematic Reviews registration (CRD420251012764), major databases (PubMed, Scopus, Cochrane Library, Web of Science) were searched up to 5 March 2025, without language or date restrictions. Comparative studies (randomised controlled trials and observational studies) reporting perioperative, postoperative, and recovery outcomes for VATS versus OTS were included. Data were synthesised using random-effects models (calculating mean differences [MDs] or risk ratios with 95% confidence intervals). Heterogeneity (I²), risk of bias (Risk Of Bias In Non-randomised Studies of Interventions) and publication bias (Doi plots, Luis Furuya-Kanamori index) were assessed.

Results

Nine retrospective cohort studies met the inclusion criteria. Compared with OTS, VATS was associated with significantly shorter operation times (MD −38.08 min; p<0.001; I²=92%), lower perioperative blood loss (MD −64.02 mL; p=0.006; I²=98%), reduced postoperative drainage volume (MD −124.46 mL; p=0.003; I²=85%), earlier chest drain removal (MD −2.27 days; p<0.001; I²=92%), and shorter hospital stays (MD −3.68 days; p<0.001; I²=98%). Although VATS showed a trend towards fewer postoperative complications, the difference was not statistically significant (risk ratio 0.72; p=0.13; I²=0%). Significant heterogeneity (I²>85%) was present for most continuous outcomes, and risk of bias assessment indicated high risks in confounding and reporting domains for several studies. Potential publication bias favouring VATS was detected for multiple outcomes.

Conclusions

VATS appears to offer significant perioperative and recovery advantages over OTS for the surgical management of pulmonary hydatid disease. However, these findings must be interpreted with caution. While this review incorporates recently available randomised evidence, the majority of the data remains retrospective, and the pooled results are affected by significant heterogeneity and a high risk of bias in several domains.

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视频辅助胸外科与开放胸外科治疗肺包虫病的疗效比较：一项系统综述和荟萃分析。

背景与目的：由棘球蚴幼虫引起的肺棘球蚴病或肺包虫病是一项重大的健康挑战，特别是在流行地区。虽然手术是治疗存活囊肿的主要方法，但最佳方法仍在争论中。传统的胸腔镜手术（OTS）与微创胸腔镜手术（VATS）缺乏比较证据。本系统综述和荟萃分析旨在全面比较VATS与OTS治疗肺包虫病的疗效和安全性；它将通过纳入所有年龄的患者并进行详细的亚组分析、敏感性分析和发表偏倚评估来扩展先前的研究。方法：根据系统评价和meta分析指南的首选报告项目和国际前瞻性系统评价注册（CRD420251012764），检索截至2025年3月5日的主要数据库（PubMed, Scopus, Cochrane Library, Web of Science），无语言或日期限制。比较研究（随机对照试验和观察性研究）报告了VATS与OTS的围手术期、术后和恢复结果。使用随机效应模型（计算平均差异[MDs]或95%置信区间的风险比）合成数据。评估异质性（I2）、偏倚风险（非随机干预研究的偏倚风险）和发表偏倚（Doi图，Luis Furuya-Kanamori指数）。结果：9项回顾性队列研究符合纳入标准。与OTS相比，VATS显著缩短手术时间（MD -38.08 min; p2=92%），减少围手术期出血量（MD -64.02 mL; p=0.006; I2=98%），减少术后引流量（MD -124.46 mL; p=0.003; I2=85%），早期胸腔引流（MD -2.27天；p2=92%），缩短住院时间（MD -3.68天；p2=98%）。VATS虽有术后并发症减少的趋势，但差异无统计学意义（危险比0.72;p=0.13; I2=0%）。大多数连续结果存在显著的异质性（i2bb085%），并且偏倚风险评估表明，在一些研究的混杂和报告领域存在高风险。在多个结果中发现了支持VATS的潜在发表偏倚。结论：在肺包虫病的外科治疗中，VATS似乎比OTS具有明显的围手术期和恢复优势。然而，这些发现必须谨慎解读。虽然本综述纳入了最近可获得的随机证据，但大多数数据仍然是回顾性的，并且合并的结果在几个领域受到显著异质性和高偏倚风险的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart, Lung and Circulation CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.50

自引率

3.80%

发文量

912

审稿时长

11.9 weeks

期刊介绍： Heart, Lung and Circulation publishes articles integrating clinical and research activities in the fields of basic cardiovascular science, clinical cardiology and cardiac surgery, with a focus on emerging issues in cardiovascular disease. The journal promotes multidisciplinary dialogue between cardiologists, cardiothoracic surgeons, cardio-pulmonary physicians and cardiovascular scientists.