Author of

• 11851

  +

  P2.16 - Poster Session 2 - Other Thoracic Malignancies (ID 187)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Thymoma & Other Thoracic Malignancies
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11854

    +

    P2.16-003 - The efficacy of VATS versus open thoracotomy: a systematic review (ID 1867)

    09:30 - 09:30  |  Author(s): P. Herle
    • Abstract

    Background
    VATS has become an increasingly popular technique for the cardiothoracic surgeon. Its use in the treatment of malignancy has been an issue of debate previously. Whilst its use has been documented for the treatment of primary lung cancers, its use in metastasectomy has been brought under question for several reasons. The low sensitivity of pre-operative CT in diagnosis of metastatic disease in the lungs, compared to palpation means that VATS may miss resection of metastatic lesions. VATS has also been associated with pleural and port site seeding. Whilst there have been several studies demonstrating roughly equivalent survival and more rapid post-operative recovery in minimally invasive approaches, there remains no randomised trials and other high level evidence regarding the oncological outcomes of VATS versus open thoracotomy for pulmonary metastases. This article attempts to provide a systematic review of studies which have directly compared open and VATS resection of pulmonary metastasis in terms of outcome.

    Methods
    The study followed the PRISMA protocol for systematic reviews and meta-analyses. The search strategy included an electronic literature review using the PubMed database. The MeSH terms utilised were pulmonary metastasectomy, VATS, thoracoscopic and open. The inclusion criteria for the studies are that they had to have 2 limbs for direct comparison of VATS and open thoracotomies. The studies should also provide data regarding overall survival data or recurrence free survival data separately for the 2 limbs of the study.

    Results
    Nine studies with 777 patients fulfilled the inclusion criteria. The VATS groups had slightly higher odds of 1, 3 and 5 year survival with OR of 1.53, 1.69 and 1.41 respectively. All these results demonstrated no heterogeneity on testing. However, only 3 year survival was statistically significant for overall effect. The VATS group also had higher odds of 1, 3 and 5 year recurrence free survival with OR of 1.29, 1.54 and 1.54 respectively for each of these outcomes. Once again the tests demonstrated no significant heterogeneity on testing. None of the outcomes demonstrated statistical significance in testing for overall effect. Overall pulmonary recurrence had lower odds in the VATS group with an odds ratio of 0.55. This data was not significantly heterogenous (p = 0.15) and did not demonstrate statistical significance in testing for overall effect also (p = 0.28).

    Conclusion
    Outcomes from VATS are comparable to, if not better than, open thoracotomy. VATS is a suitable choice for pulmonary metastasectomy.