微创与开放式胸壁切除术治疗非小细胞肺癌:一项系统综述和荟萃分析。

IF 3.5 2区 医学 Q2 ONCOLOGY
Translational lung cancer research Pub Date : 2025-07-31 Epub Date: 2025-07-28 DOI:10.21037/tlcr-2025-358
Paula Duarte D'Ambrosio, Rachid Eduardo Noleto da Nobrega Oliveira, Marcelo Albuquerque Barbosa Martins, Isabella Cabianca Moriguchi Caetano Salvador, Luiza Gonzalez de Andrade, Ricardo Mingarini Terra, Paulo Manuel Pêgo-Fernandes, José Ribas Milanez Campos
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引用次数: 0

摘要

背景:微创胸壁切除术(MICWR)已成为开放式胸壁切除术(OCWR)治疗肺癌的替代方案。本荟萃分析旨在比较MICWR和OCWR的围手术期结果,以评估微创入路的安全性和可行性。方法:系统检索PubMed, Embase和Cochrane图书馆,直到2025年1月20日,比较成年非小细胞肺癌(NSCLC)患者MICWR和OCWR的研究。效果测量包括二元结果的优势比(ORs)和连续结果的平均差异(MDs)。采用随机效应模型进行统计分析。采用I2统计量评估异质性。结果:3项回顾性研究包括2,973例患者,其中26.3%的患者接受了MICWR, 73.7%的患者接受了OCWR。两组总死亡率无显著差异[OR 1.12;95%置信区间(CI): 0.95 ~ 1.32;P = 0.17;I2=0%]或90天死亡率(or 1.00;95% CI: 0.74 ~ 1.34;P = 0.98;I2 = 0%)。MICWR显著降低了总并发症(OR 0.36;95% CI: 0.14 ~ 0.93;P = 0.04;I2 = 0%)。而初步分析显示住院时间(LOS)无显著差异(MD -4.92天;95% CI: -10.36 ~ 0.52;P = 0.08;I2=84%),敏感性分析(left - 1 -out)消除了异质性(I2=0%),并显示显著的LOS降低有利于MICWR (MD -7.62天;95% CI: -11.34至-3.90)。结论:MICWR提供了与OCWR相当的肿瘤预后,同时减少了术后并发症。它也可能缩短某些患者的LOS。然而,证据仅限于回顾性研究,需要前瞻性试验来证实这些发现并确定最佳标准。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Minimally invasive vs. open chest wall resection in non-small cell lung cancer: a systematic review and meta-analysis.

Background: Minimally invasive chest wall resection (MICWR) has emerged as an alternative to open chest wall resection (OCWR) for lung cancer. This meta-analysis aims to compare perioperative outcomes between MICWR and OCWR in order to evaluate the safety and feasibility of the minimally invasive approach.

Methods: A systematic search of PubMed, Embase, and Cochrane Library was conducted until January 20, 2025, for studies comparing MICWR and OCWR in adult patients with non-small cell lung cancer (NSCLC). The effect measures included odds ratios (ORs) for binary outcomes and mean differences (MDs) for continuous outcomes. Statistical analysis was performed using random-effects models. Heterogeneity was assessed with I2 statistics.

Results: Three retrospective studies comprising 2,973 patients were included, with 26.3% undergoing MICWR and 73.7% undergoing OCWR. No significant differences were found in overall mortality [OR 1.12; 95% confidence interval (CI): 0.95 to 1.32; P=0.17; I2=0%] or 90-day mortality (OR 1.00; 95% CI: 0.74 to 1.34; P=0.98; I2=0%). MICWR significantly reduced overall complications (OR 0.36; 95% CI: 0.14 to 0.93; P=0.04; I2=0%). While primary analysis showed no significant difference in length of stay (LOS) (MD -4.92 days; 95% CI: -10.36 to 0.52; P=0.08; I2=84%), sensitivity analysis (leave-one-out) eliminated heterogeneity (I2=0%) and showed a significant LOS reduction favoring MICWR (MD -7.62 days; 95% CI: -11.34 to -3.90).

Conclusions: MICWR offers comparable oncologic outcomes to OCWR while reducing postoperative complications. It may also shorten LOS in selected patients. However, evidence is limited to retrospective studies, warranting prospective trials to confirm these findings and define optimal criteria.

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来源期刊
CiteScore
7.20
自引率
2.50%
发文量
137
期刊介绍: Translational Lung Cancer Research(TLCR, Transl Lung Cancer Res, Print ISSN 2218-6751; Online ISSN 2226-4477) is an international, peer-reviewed, open-access journal, which was founded in March 2012. TLCR is indexed by PubMed/PubMed Central and the Chemical Abstracts Service (CAS) Databases. It is published quarterly the first year, and published bimonthly since February 2013. It provides practical up-to-date information on prevention, early detection, diagnosis, and treatment of lung cancer. Specific areas of its interest include, but not limited to, multimodality therapy, markers, imaging, tumor biology, pathology, chemoprevention, and technical advances related to lung cancer.
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